"a rather worrying trend of births to [older] women"

As I have already said - the PPH was called after my daughter was already born, though a small bit of bleeding was noticed as we were making our way to theatre. I was holding my daughter when my husband and I heard the team call “PPH, PPH” and watched the blood loss volume going up on the theatre white board to 2.9l. The doctor said afterwards “we think you were having a placental abruption”.

I did have an obstetric debrief with a consultant, and she reiterated both points: abruption, PPH. She said that due to the team’s vigilance with the CTG and decision to get our daughter out right away it was caught early - certainly before our daughter was affected.

I have since had two pregnancies (both ELCS) and both points were discussed at length with the consultants and anaesthetists when planning for said sections. As you probably know, once you’ve had an abruption you are more likely to have another than the general population. So we chose earlier delivery to the ensure I did not go into labour naturally, having balanced the pros and cons each way.

I don’t think three consultants, one doctor and two anaesthetic consultants are likely to have been using the wrong terminology, or misunderstood what happened.

I am pro women giving birth where they want. They said it wrong or you understood it wrong. You cant have a PPH when youre still pregnant
You can have an APH which becomes a PPH after birth and an APH is a risk factor for a PPH. It's important that you understand exactly what happened. You can request an obstetric debrief at any time to find out.

@LoftyRobin the theatre team called it a PPH - both my husband and I heard them call it out at the time. The order was - heart beat decelerations started - decelerations didn’t improve - taken to theatre - as we were taken to theatre the midwife noticed some bleeding - daughter out - team called out PPH - PPH treated, while I was holding my daughter.

I understand that you’re very pro home birth, which is totally within your rights. But that really wasn’t my experience of the labour ward at all. I had a midwife with me at all times, and she was paying pretty close attention. The doctor came in as soon as the CTG started showing decelerations. He scanned me twice to figure out the baby’s position. We had a discussion with the doctor and agreed to let me push for a bit. The decelerations didn’t improve so the doctor came in again. We had another discussion to agree the way forward - I asked for a C section, but the baby was very low so the risks were explained to me. I agreed to try instrumental while being prepped for section just in case. Etc. They were extremely hands on and I felt very very well looked after. It felt like a very well oiled machine.
In fact, reading through my notes at the debrief, the consultant said the team had done extremely well to spot the early signs and prevent a dangerous situation from developing. She asked me if I wanted them to receive a special commendation for it, which I did. I am extremely grateful to them for how good - and kind- they were, and I said so to her at the debrief.

I thought the significant factor was if it was your first child as an older mother, women have been having subsequent babies after 40 for ever. Also the increased risk of chromosomal abnormalities, but this risk can now be managed with nipt, abnormalities scans (which are mindblowingly detailed now and if necessary/ wanted TFMR.

This isn't OP first baby, so it does seem that she is attracting a lot of drama for a normal natural life event.

@LoftyRobin you sound like you have lots of experience and I'm always interested to learn general information, procedures, statistics etc about pregnancy and birth, so thank you.
But no amount of experience can tell you what happened to a particular woman in a particular situation given only a few basic facts and it's frankly irresponsible to pretend otherwise. Not to mention dismissive to pretend you know better than she does what happened to her.

The trend for later first time motherhood is a new one. Pre reliable contraception, women had babies until they couldn’t any more. My grandmother had three babies in her forties, and that was back in the fifties and sixties.

Okay i missed this, an abruption isnt a PPH, it is an APH. PPH means "post partum haemorrhage", or "after birth haemorrhage", an APH is a before birth haemorrhage. Your daughter wasn't born yet so it was an APH.

Abruptions and similar haemorrhages are often picked up on intermittent ausculation and basic palpation and transferred accordingly. In labour ward, we may take longer to recognise that there is a theatre worthy bleed than if at home or in the birth centre because we would recommend tranfer as soon as we felt something was wrong to get you on a CTG. In labour ward, you'd already be on a CTG, we wouldn't be as hands on with you, and we would likely take longer to see that you have symptoms of abruption. Why? Because people are stressed in Labour ward, yheg are of hugher risk and the machines don't always work properly, and so we are used to seeing abnormal CTGs.

We are not used to hearing weird heart rhythms at home. We are not used to the type of hard tummy one has once abrupting.

There's every chance that the first midwife who would have come to assess you at home would have felt a hard tummy, heard an abnormal heartbeat, and transferred you in from then.

I’m so sorry to hear that. Xx

I did lose it in theatre.

My daughter’s heart rate was showing decelerations and I had some bleeding, I was taken to theatre, they got her out and then I had the PPH. The doctor at the time, and then the consultant at the debrief said it was likely I was having a placental abruption.

You wouldn't have lost it in theatre. You'd have lost that in the room where they'd have stopped the active bleeding and taken you to theatre.

@EarlGreywithLemon thank you, but to be honest mine was much less serious, do technically a major PPG but not the same. Mine was only slightly over 1L and from the notes and the debrief it sounds like it was mostly due to my labia tearing. For various reasons I suspect it wouldn't have happened if I'd stayed at home, but either way it was under control pretty quickly.
The only thing I found traumatic about the birth was what the midwives in hospital did to me after I transferred, but that's another story x

That’s very kind, thank you - it sounds like the same happened to you, so I’m so sorry. X

Luckily everyone was so calm and looked like they knew exactly what they were doing, so it wasn’t traumatic. I had the baby with me the whole time too. I think I would have felt very scared bleeding out at home and being whisked away in an ambulance though.

I had a baby at 42. Came on due date, easy natural birth. The day before I was in the gym doing body combat. I appreciate that there are increased risks. They didn’t apply to me and I’m thankful for that. None of this is to say I wasn’t anxious. I’m 56 now, he’s 14. He also has autism. I’ve come across a lot of older parents who have had autistic children.

@EarlGreywithLemon I'm sorry you went through that, it sounds absolutely terrifying. Glad you had a medical team you felt confident in x

I take it you are a midwife?

I can’t comment from a medical point of view, but as a patient I was very reassured to be losing 2.9l of blood in theatre, with a big medical team around me, and all the facilities they could possibly need to deal with it.

Its really pretty rare for someone to need a hysterectomy after a PPH. It isnt unusual for some midwives never to care for someone that goes on to need one for those reasons. It depends where you work.

Most in the hospital are stopped by the drugs that midwives carry to homebirths as well as prediction of who is at increased risk which comes with clinical knowledge and lived experience. The woman may need further care in theatre but they are out of danger. Very few people need literal life saving care in theatre. What they need in theatre is repair and complete removal of all placental tissue.

This. Before the pill was available, late pregnancies were common. My dm had babies at 38, 42 and 44, and miscarriages at 40 and 45. That was in the 50s and early 60s

@LoftyRobin you might have a medical background (I don’t). My PPH was due to a suspected placental abruption, so I’m not sure if the management would be different. I do believe though - correct me if I’m wrong - that if the PPH doesn’t stop via other methods, it’s ultimately a matter of a hysterectomy, not to mention fluids or a blood transfusion on the spot. Surely those can’t be done at home?

As for midwives/ consultants, my notes had me as moderate risk due to age, with scans at 32 and 36 weeks followed by obstetric review. I saw the obstetric consultants three times as part of the joint obstetrics cardiology clinic.

As an aside I found the consultants very level headed, and not at all jumpy or keen to over diagnose. The midwives were pretty variable. I saw an excellent one two or three times, but even she couldn’t answer all my questions and told me to ask the consultants. The others were very nice, but often gave me contradictory advice which I then had to make sense of at the consultant appointments.

@EarlGreywithLemon no, of course it's not for everyone. As you say we're all different and if hospital is where you feel safe then that's the right place for you.
Anyway, that study doesn't apply to you personally if you've had a previous pph (or to me as I've had the same but I'm balance I still feel better staying home). I just think it's good to be aware that many things we take/took for granted as being safer/beneficial were introduced without any evidence and either still lack any evidence or have been shown unsafe. For some other examples CTG, routine vaginal exams, directed pushing, various forms of perineal protection, optimal fetal positioning/spinning babies, sweeps, immediate cord clamping, routine augmentation at hour X, elements of 3rd stage management, etc.

I recently gave birth and was under consultant care for having had previous small babies. However a mistake had been made duplicating a record which meant I had an extra pregnancy documented and would need to correct them at each appointment. I was told I would be induced due to small babies but as current baby growth scans were fine in the end they induced me due to me being 40! That’s ridiculous as I know of women 44 /42 who were left alone and labourer naturally and were not labelled high risk due to age!

I had two babies in my early twenties, pregnancy was easy as was the births. My body recovered quickly and I had boundless energy that got me through the sleepless nights etc.
i had a baby in my late thirties and massively struggled with my health, mental health and weight. My body never fully recovered and I struggled with having a young child.
had the baby been my first I wouldn’t have had the comparison but it was so much harder when I was older.

Every single pregnant women is seen by midwives regardless of the risk status of your pregnancy. Even if you are expecting triplets, you'd still have midwifery appointments between scans and obstetric consultations if it was feasible. I have known of people who never ever saw a midwife alone for their entire pregnancy, but it was literally because they saw the doctors every week at the hospital clinic so only saw the accompanying midwife there. Their pregnancies were ultra high risk.

For most women deemed high risk, they might have a obstetric appointment at 20 weeks and maybe towards the end and at these appointments, the obstetricians would plan the extra care they need like scans or extra appointments for check ups with the midwife.

There is no way that NHS obstetricians would agree that it is in anyone's interests for them to lead all appointments with every woman deemed high risk. They dont have the time and they'll admit themselves that they'll start finding problems that aren't there.

Most of the protocol for PPH can be applied at home. It starts with rubbing up a contraction, drugs, maybe bimanual compression, and delivery of the placenta. The vast majority are solved in the labour room using things that you would have at home. Women make adaptations in pregnancy to counteract significant blood loss in labour.

Its weird because everyone I know recently been in there 40s and has successful pregnancies and babies. My youngest I had single at 40 and twins at 41 all home births same as my oldest children all went great

Having researched my family tree I can confidently say you're talking shite.
I have documented proof of many many women in their 40s having babies going back to the early 1800s including my great grandmother who gave birth to my grandmother ( her 4th baby) aged 42.