What are my 'High Risk' birth options?

[NotSleepyAtAll]

I'm in the high risk category because my first delivery resulted in a Post Partum Haemorrhage but also because my BMI is above the parameters for low risk. Last pregnancy was low risk.

I have to have an additional consultant led appointment this time around because I'm high risk. I'd like to go prepared.

Has anyone experience of this additional appointment for high riskers?

What are my options (if any!!) for delivery?

Thanks

[KnitsBakesAndReads]

No experience of the consultant appointment, but I was low risk for almost all my pregnancy and then was put in the higher risk category late on due to a potential complication. I was told that the only option for delivery was a hospital labour ward. I'd previously planned to go to a freestanding birth centre.

However, I have heard of people who are higher risk being able to go to a birth centre based in hospital where they could be quickly transferred to labour ward if needed. My hospital doesn't have an on site birth centre so that wasn't an option for me but it might be worth asking about that if you'd prefer a midwife led unit instead of consultant led.

I had a PPH too and was told they recommend an elective c section for my next pregnancy. To be honest, even if they hadn't said that I would definitely not be comfortable anywhere other than a hospital labour ward given how scary the whole PPH situation was this time and how grateful I was to be somewhere where they could give me treatment as quickly as possible.

[Annabrooke90]

I had a PPH in my first birth. The rest have followed as high risk. During the consultant appointment the plan of birth has been discussed. In my town there is only really hospital or home I could birth at anyway. I've always gone with the hospital as I'd feel unsafe at home given my past experiences. The things that's mainly been discussed are that I'd had to have a cannula fitted in labour and the things at that would be needed on hand after just incase. With ds2 I actually laboured in the HDU unit as that's where I ended up with ds1. Water birth was out of question (which is what I wanted for all of my births) until ds4 where the consultant said we would see how everything progressed and if I was fine through the pregnancy then I'd be allowed to labour in the water, but would have to get out to birth. As it happened ds4 came at 34 weeks so I didn't get the water birth. I also had a w follow ups with the consultant through pregnancy.

[dats]

Can I just ask: those of you who had a PPH, do you know what volume of blood you lost?

[gingerbreadmanm]

Hi sleepy congrats!

I had a PPH after an MMC. That made me high risk the next time along with my BMI too which was around 35.

From what i remember i was going to be in the high dependency labour area automatically. They would administer drugs to help the placenta come away and stop the chance of another PPH and i would have regular monitoring of the baby throughout labour. Water birth would be ruled out.

As it happened ds died at 27 weeks (we had found out there was an anomaly although not life threatening at 20 weeks). I was induced and the only thing different to other people giving birth i think was me having the drug for the placenta / PPH.

Hope that helps. I actually found it reassuring when pregnant knowing i would be montiored closely in labour.

[Mummyme87]

If you had a previous PPH your would be high risk for the third stage not the actual labour. Monitoring of baby should be intermittent auscultation (every 15mins). The PPH does not affect the baby and nothing about the baby will tell the team you are more likely to have another PPH. However probably advise for cannula if it was a significant amount ie. Over 1000ml, active management of 3rd stage. You will be advised against using midwifery led unit but it depends on why you had the PPH.. If it was from a tear then it's very different from a uterine bleed

[Fourormore]

I had PPH in my second birth and my BMI is about 35. My third was a home birth and I'm expecting my fourth now which will also be a home birth.

[Fourormore]

Second, third and fourth were/will be water births.

[skankingpiglet]

Your options really depend on the reason for being put as high risk. One of the purposes of your consultant appointment is to go through your risks and birth options, so don't worry if you don't have all the answers before you get there.

I don't have experience of your risk factors, but I am high risk as I'll be a vbac (all going to plan!). As I knew that in advance I researched why it pushes me into that risk category (uterine rupture), what if anything I can do to reduce the risk, and the odds of it happening. Because last time my only issue during pregnancy was a non-compliant breech baby, and this time the fact I've previously had a section, the consultant after much talk agreed to let me use the MLBU and the birthing pool. This is only because the MLBU is next to the consultant-led labour ward, and I'll still be under consultant care officially. I've also had to agree to constant monitoring. Their standard policy is all high risk go to the labour ward, so I am aware how lucky I am.

Even if you do end up on the labour ward, it doesn't mean being tied to a bed on your back (unless that's what you want!). Again depending on your risks, your options include active birthing, using the bath/shower (and ours has an inflatable pool), birthing balls and mats. You can still request to just have midwives in the room with you unless there's a problem, still have immediate skin to skin etc.

[gingerbreadmanm]

Forgot to add that the cannula thing was probay the main reason so u were already prepped for medication / transfusion if needed.