AIBU to be worried I’ll die in childbirth

[TheBerry]

Basically I’m pretty worried I could die during the birth of my second child, and I was wondering whether anyone has had a similar experience to me.

Immediately upon delivering DD1 a few years back I had a really rapid haemorrhage. I lost a little over 1 litre in less than a minute due (I guess) to retained placenta, but fortunately my epidural was very effective and so they were able to immediately get up in there and remove the remaining placenta manually and the bleeding then stopped.

So now on my notes it mentions that I had a pph of 1L, which I understand by itself isn’t mega uncommon or a catastrophic event, but my concern is the speed at which it happened. From what I can see, for most people who haemorrhage this amount or more it happens a bit more slowly, even over a period of hours, but if I haemorrhage again at the same rate as last time and I’m not at hospital or quick action isn’t taken I’ll be dead within 10 minutes. I kind of feel that now I’m pregnant with DD2 the doctors are looking at my notes and just seeing 1L and thinking “that’s not too bad” without really taking into account how quickly it happened. I’m just feeling really uninformed and out of control and I don’t really know what I should do for my birth plan or what measures should be taken. DD1 and I ended up in hospital for a week due to the pph and also due to being placed on the sepsis pathway.

One of my concerns is that I’ve made the wrong choice of hospital. I’m less than 5mins from the local hospital, but it’s a pretty bad hospital. My mum nearly died there 30 years ago from a haemorrhage after a miscarriage due to lack of care of their part (which they admitted), I’ve personally had terrible experiences there with miscarriages, and I know other people have too. So, I had an induction with DD1 at another hospital, which is a very good hospital, and specialised in maternity… but it’s up to an hour’s drive away if the traffic is bad. There’s no history of very fast labours in my family but I guess I’m worried if I start to bleed out on the motorway on the way to hospital I won’t make it. So I don’t know whether I should switch to the local hospital, or opt for an induction again so it’s more controlled, or a c-section, or just wait for labour and risk the hour’s drive (which my consultant said would be fine but, again, I’m not positive she’s really considering the speed of the pph last time).

There’s another thing that’s really shaken me. A girl I’ve known for 20 years had complications with her first birth a few years ago and stayed in hospital for a week, same as me. She was recently pregnant with her second. She was at term and something went terribly wrong and she and her baby died. There is a 2-week inquest set for later this year (which is very long for an inquest). I expect there will be media coverage at the time and probably CQC recommendations. I keep thinking there must at the very least have been failures in her care, and she probably trusted her doctors who ultimately let her down. I’ve been trusting my doctors too, but I’m wondering if I should do more and push for another review of my history and a more rigorous protocol.

I can’t shake the feeling that I’m going to die. I can’t imagine just being ok and going home with my new baby and DD1 and DH. My family are excited and keep talking about the future and I’m like haha yeah but I’m just faking it because really I don’t think I’ll be there. I hope the inquest findings bring changes which make this kind of unthinkable event less likely to happen to other women, but it’ll be too late for me because I’m due before the inquest. I know anxiety and trauma can make you feel these kinds of things, and it doesn’t necessarily mean anything, but I can’t shake the feelings and it’s quite distressing.

Apologies for the long post!!

Please seek advice from your health care team. Ask for it to be noted how fast it was last time.
Dying in childbirth is very rare here but I guess that's no comfort.

I also had a massive PPH after my first baby. I didn't after my second baby, albeit she was much smaller than her (normal-sized) big brother. I hope that's reassuring.

Like you, it happened very quickly.

I think you would be more than reasonable to ask for a c-section at the better hospital, to have certainty about when your baby will be delivered and that you'll be in a medical facility that you trust. I think you should talk to your midwife and be prepared to be quite firm about it if she isn't helpful.

I had a post partum haemorrhage after my second child but not my first so try and seek reassurance from the fact it doesn’t happen every time.

Also it happens after the baby is born so, provided your plan is to give birth in the hospital, you’ll be there already when it happens. Unless somehow you go into labour at home and you manage to give birth and haemorrhage within an hour (time you said it will take you to get to the hospital) then it’s very unlikely.

But, if it’s stressing you out and worrying you this much, look into elective C sections and see if that’s an option for you? Stressing over this won’t be good for your baby and I know that the rarity of death in childbirth and the unlikelihood of bleeding out on your way to hospital won’t be sufficient to set your mind at rest because you know those statistics already.

@TheBerry Hi OP. I’m going to tell you my story in the hope that it gives you some comfort. I had a pretty traumatic birth for my first child. I woke up in the middle of the night with contractions and called my mum (who is a nurse) and whilst on the phone with her I found that my dad had passed away. Suffice to say I was completely devastated. I ended up in labour for 46 hours, and then an emergency c-section as my baby’s heart became erratic and they were in distress. Once baby was born - I started losing so much blood, baby and daddy where swept off the OP room and I kept going in and out of consciousness whilst doctors worked on me. I had many transfusions and at one point they considered removing all my reproductive organs. It was scary and just an experience I wouldn't want to relieve. The good thing is - once you have an experience like this - you keep reminding them of it if you have more kids- which I did. I went on to have 2 more completely normal births. Perfect and healthy kids. 2nd child I was in labour for 14 hours and third for 7.

So one birth doesn’t mean the others will be the same.

Another thing to consider is to talk to your doctor about having an elective c-section? Whilst my c-section was traumatic my sister had an elective one and she has nothing but good things to say about it. If they are planned they can be easy to manage. And I mean easy in the context of child birth! Not in an elective c-section is a breeze.

I had a 900ml immediate PPH after my first, OP, due to retained placenta. It didn’t happen with my second or third, but the teams were aware of my history and monitoring me closely. As long as you deliver in hospital everything should be fine.

I also had a PPH with my first that happened quickly after a forcep birth. I was in theatre so they could act quickly.

I opted for an elective c-section with my second as I couldn't go through all that again. That all went fine and I made a speedy recovery. A lot better than my first recovery.

I had exactly the same fears when pregnant with my second; having had a PPH with my DD, and compounded by being told early on that my placenta was covering my cervix. We live rurally on a smallholding with livestock, a puppy and a toddler so taking it easy was never going to be an option and given Amazon struggle to find us some days I couldn’t imagine an ambulance getting to us in a hurry if needed. I was absolutely certain I would die, so much so I internally considered my due date to be my death date. I grew ever more anxious with every week and struggled doing fun family things without getting emotional at the thought DD wouldn’t remember me.

Our second is now 3 months old. His birth was fast (as in almost didn’t make it to the hospital in time) but completely uneventful. Whereas last time I had a lengthy stay for induction, followed by a weeks stay for infection, this time I was in and out in a matter of hours. There were absolutely zero complications or interventions, and with hindsight I look back and wish I’d enjoyed my pregnancy more.

Obviously it’s completely understandable to be anxious given what happened to your mum and your friend, but statistically at a litre or less of loss you’re not at a heightened risk of a bleed this time around, and if anything the hospital will be more prepared if you were to have a bleed than they were with your first as they know it’s happened before.

I would recommend asking if you can have a birth options discussion with a consultant midwife. I found mine really helpful (if a bit emotionally painful) - she went through my history in my first pregnancy / birth with me and then we discussed any issues in my second pregnancy to agree a birth plan. We went through all the risks and benefits - it took about 90mins. She was very thoughtful and practical - didn't push me at all either way. Only after I'd confirmed my choices, did she say that she thought I had made the best decision for me in declining a ECV (breech baby). Anyway, it might help you to talk through all your options with someone impartial and especially to flag the speed with which your PPH happened.

I would also add that statistically, second labours tend to be much faster (and easier) than first labours. So having a plan will be reassuring. For example, the consultant midwife told me to come to the hospital as soon as I felt any twinge of contraction or water leaking so they could get the process going. Even to bring DD1 if I didn't have childcare rather than wait at home (in the end, I went into labour whilst DH was at home, so i went first in a taxi and he followed once SIL arrived to look after DD1). Things like that helped me feel reassured a bit more that everyone knew what was happening and what our plan A plus plan B would be.

I lost 2L in the first 5 minutes and a further 6L over the next hour and I survived.

This was 2nd baby, lost about 500ml with first. Probably best to give birth in the hospital where you can be in theatre within minutes.

I know what you mean about the speed. I lost 2.5l during my planned section with first baby and it was scary I remember passing out etc and the panic of the doctors.
They advised me a section would be safer next time and that's what I plan

I had a similar experience with my first pregnancy, although not as long in hospital.

For my second, I got referred to a consultant for having a PPH by the midwife but then they said it was probably fine/normal with a forceps delivery and signed me back to the midwife.

With my second it was a very quick labour and my notes actually said zero blood loss (which is impossible!). I was expecting massive issues but the second birth was so much better.

I would suggest if you do go into labour spontaneously go to the hospital straight away if it’s an hour away and consider a back up plan of going to the nearer one if contractions progress quickly.

While its unlikely you will die your concerns are valid /have some basis.

I lost 1.5l in my first pregnancy and only 300ml in my second.

If i was you I would go for an ELCS at around 39 weeks at the further away hospital.

But really you should talk to a few consultants and get their opinions.

Your notes will detail your last PPH & will have a plan for this time as you are at a slightly increased risk. You should be admitted to the obstetric side of the unit & be under consultant care so will be reviewed on the ward round if you labour long enough. You will be cannulated as soon as you go into labour & have a syntocinon infusion written up & ready to be administered as soon as you have given birth. This helps contract the uterus, so you don’t haemorrhage. PPH is quite a common occurrence, but is easily managed, we had at least 1 or 2 per shift when I was a labour suite midwife. All qualified staff regularly undertake obstetric emergency ‘skills drills’ to prepare for this & remain competent. A CS doesn’t decrease the risk, you can still PPH after a CS, although you would be in theatre & have a large team around you. You will be well looked after & wont die.

Thanks everyone for your responses. They’ve been really helpful.

I actually was set on a c-section this time around because I did think it would be safer, but I had a chat with the consultant recently and she said actually I’m just as likely to have “sticky placenta” with a c-section as a vaginal delivery, plus the added blood loss from the c-section itself, so I might actually lose less blood from a vaginal birth with manual removal of the placenta. I guess I’m ok with that, but obviously the caveat is that I need to be in hospital on time. The consultant seemed to think the drive to the hospital wasn’t risky and I’d have plenty of time for labour. She was very nice, and pretty persuasive, but idk, I’ve had conflicting information.

I am having a birth plan session with a consultant midwife, but I was thinking of asking to have it with a consultant obstetrician instead. However, if the consensus is that a consultant midwife is good then I guess I’ll stick with that? I suppose I thought she might not have quite as much knowledge as a doctor.

No experience of pph but a lot of your post resonated with me. My first birth with my son was traumatic for several reasons and we ended up staying in for a week after. I also lost a lot of blood and nearly had to have an infusion. All in all it was a horrible experience and not helped by him being a very colicky baby who cried nonstop for the first 9 months.
I became pregnant the second time accidentally, I honestly didn't think I'd have another because things had been so hard with my first. And I spent the whole of that second pregnancy convinced that either me or my baby would die during labour, I used to lie awake most nights crying about it. In retrospect I definitely had post partum depression the first time. So I was truly terrified (and that made me terrified that my stress would lead to problems during pregnancy..) BUT I went into labour naturally with my second (first had been an induction) and had a smooth labour - much easier and less stressful when it came to it than the first time and me and my daughter were both absolutely fine and home the next morning. It was a completely different experience. And the newborn days were gorgeous that time around! So I'd suggest speaking to your doctor about what happened last time but please know that it's possibly to have a totally different, good experience this time.

You could ask for an elective at the better hospital but the risk of haemorrhaging is higher with a c section. I had the same worries as you re dying childbirth is no joke and I’d lost my mum suddenly and unexpectedly 5 weeks before delivering my first so I was all too familiar with how unfair and cruel life could be taking healthy people that were needed so much. I could not rationalise my thoughts at all

The consultant midwife will have up to date, evidence based knowledge and will take a person-centred approach to your birth plan. They certainly know as much as the obstetricians - they’re both consultants in their respective field and a consultant midwife is a clinical expert.

Oh bless you. I’m a midwife and I do understand how your previous experience coupled with the death of the woman you knew could really make you fear the worse.

dying in childbirth in this country is very, very, very rare. You will be considered higher risk due to your previous pph but that means you will be cannulated for iv access and a really close eye kept on you afterwards. 1ltr in a minute sounds a lot but to be honest as a midwife it’s something I’ve seen quite a bit (over 20 years) and not something I’d be freaking out about. We train a lot for stuff like this and know what to do. Sounds like it was dealt with well for you, if removing that placenta hadn’t worked to stop the bleeding there are other stages to move to, drugs, etc which work well. There’s always emergency blood on the Labour ward and we can generally squeeze it in as fast as it comes out if needed, but that doesn’t happen often.

id not opt for an induction this time round if you can avoid it as it does slightly raise the risk of retained placenta and pph. The consultant midwife will know their stuff but by all means ask for a consultant obstetrician appt as well if you’re not happy after seeing the midwife.

It is worth remembering that you had a PPH and survived because it was treated.

They will be especially alert to the risk and vigilant. .

Thanks, that is really helpful to hear a midwife’s perspective. I think I’ll feel better once I’m actually in the hospital, even though I’ll still be scared about it happening again and maybe taking longer to stop this time. I guess my main fear at the moment is the hour’s drive, but I think that’s still preferable to going to the local hospital which really doesn’t have good ratings at all.

I know the stats are well in my favour, but then I keep thinking about the girl I knew… she was such a great person really, very kind, outgoing yet thoughtful, funny, smart, just a special person, much better than me, and if this could happen to somebody like her I feel like it could happen to anyone.

Anyway, I’ll see how the chat with the consultant midwife goes.

Today I had the birth plan call with the consultant midwife but if anything I feel slightly worse afterwards?? And no clearer on what the safest option is. Though at the moment I’m leaning towards natural birth and driving to hospital when I feel contractions.

However, the midwife did say they’d discourage me from coming in until my contractions were close together but that worries me in case labour then progresses quickly and I don’t make it in time to hospital, or don’t make it in time to get the epidural, in which case I’d probably need general anaesthesia to fix the pph if it happened again.

Induction sounds great except it increases the risk of pph.

Feeling less and less keen on a c-section based on risk factors and the risks for subsequent pregnancies.

Idk.

I lost 2L in a PPH, when I gave birth at 22weeks - that was retained placenta situation too. The management of it was a right old mess, manual removal, surgical removal, blood transfusion and then another operation three months later to remove what had been left behind the first operation 🙄

When I had my second child, I opted for a planned C-section. It was actually seeing my DH crumble in tears when I announced in a midwifery appointment that I was keen to try for a vaginal birth that made me decide - he saw our daughter born sleeping and thought he’d lost me that day too… I wasn’t prepared to risk it again.

Totally understand your fears OP, speak to your midwife about how you’re feeling.

They will tell you anything to get out of the c-section. Yes you might lose a bit more blood, but the reaction time when you’re already in theatre is infinitely quicker. I had high risk of pph with mine (which I knew in advance), and I pushed and pushed for a section which I got in the end. I had the issues I was expecting but they were dealt with immediately because I was already on the operating table. Please arm yourself with the nice guidelines and give this one more thought

I had a PPH after having my first baby. I was induced and stuck at 9cm and although contracting and pushing she just wasn't coming out so I had a forceps delivery in theatre and lost close to 3l. She did have a 99 centile head, was 9lb 6 and had never fully engaged as I had polyhydramnios so she just floated about like a little astronaut. The Induction was well managed but my body and my baby just didn't want to do what they should. She also had to be resuscitated twice, there was meconium in my waters and she developed an infection and spent a week in NICU.

For my second baby I was very scared but wanted to try vaginal delivery again. I then showed signs of pre-eclampsia and so was admitted to start induction. After the gel didn't work and I'd been there 36 hours with nothing going on I opted for an section as I felt a well planned section in theatre was a safer option. The initial obstetrician wasn't happy but after I talked to the consultant and explained my reasoning and he read my notes he agreed that it was probably a lower risk. As it turns out my son had a malpresentation too which would have potentially made labour difficult (and also a massive head) and the reluctant obstetrician afterwards apologised. All went well and I was breastfeeding him when he was 20 minutes old rather than him being whisked off to intensive care while I was being treated. The sole issue was he shat all over me at 30 minutes old after that first feed.

If you're most worried about going into labour and speed of the birth then an elective CS before your due date may be a better option. For me it was knowing I would be in theatre and that my baby wouldn't be exhausted at delivery. Compared to my daughter being born when she didn't cry, he was absolutely furious and wriggling. I was walking round 5 hours later and able to sit down (gently) whereas with my daughter I needed a transfusion on day 2 and I'm absolutely grey in all the pictures. I am so glad I had a section and it got rid of my distress.

I hope you find the right choice for you.

I think these feelings are normal with the traumas you have been through. Definitely speak to your midwife about your worries, maybe ask for a birth debrief. This is when a midwife sits with you to go through your previous birth and help you to come to terms with it and put things in place for you in preparation for your next birth. All the best op x