PPH first time...second time better?

[Nancynew]

I am probably crazy to be writing this so soon after the birth of DC1 (5 months ago), already thinking (in the distant future) of DC2. One of the things that troubles me is having a repeat of the PPH I suffered (lost nearly 2 pints) will not go into the anxiety I felt and the long road of recovery with anaemia as those who have experienced it will know! I wasn;t told the reason for the PPH (I tore badly, but don;t think that alone could account for it, and my understanding is it is usually due to failure of the uterus to contract quickly enough at the placenta site). Anyway I know it is unusual to have a PPH, so hope that it was a one off and probably won't happen again, but then I thought, are you more likely to have another after having had one in the past?

I had a PPH with dd but with neither of my boys. With both the boys i opted for a natural third stage and I'm convinced that was what made the difference. With dd i had the jab and ended up hemorrhaging really badly and with a lump of retained placenta... with both boys i was up and walking around 20 minutes after the placenta was delivered and felt great.

I had a PPH (3 pints) with DS after having had a forceps delivery and a second degree internal tear.

Was concerned when DD was born 22 months later but with her I only lost a pint of blood (I think I tend to lose quite a bit of blood when I have a baby) and only had a small graze). Overall birth experience much better second time round

PPH more common after previous PPH but less common in second rather then first labour - so Nancy, you are more likely to bleed then another woman who has not had a PPH but less likely than you were the first time. Hope this makes sense!
Also why don't you ask the hospital to look into your notes and let you know why you bled? If it was the tear then much less likely to repeat. Just write to your midwife or the head of midwifery.

P.S. a 'natural' third stage is far more likely to lead to a PPH which is why they give the injection. SummerRain you were unlucky to have some placenta retained.

I had a PPH after DD2 (she's now 7 months); I was told that there is a higher probability of having one again and that if I do have DC3 I would have to go to the Labour Ward rather than a MLU. I was also told that I would be better off having the injection rather than a natural 3rd stage and the statistics that I have seen would appear to back this up.

Fortunately I didn't suffer with anaemia - I lost over 4 pints so had to have a transfusion and my haemoglobin levels were through the roof afterwards so I think the blood donor must have been eating nails for breakfast or something .

As I was broody for DC3 within 24 hours of DD2's birth, I don't think the experience has put me off having another, possibly because although I felt weak and feeble for a while afterwards, I wasn't in nearly as much pain/discomfort as I had been after DD1 (epi + forceps delivery).

You are more likely to have a pph if you have had one previously but it is worth looking into the reasons why you had it. I had a pph with my first baby caused by a retained placenta that had become trapped. Having looked at the research and discussed with my surgeon it was felt that because the placenta had come away from the uterus but had become trapped it was likely to have been caused by a managed 3rd stage and the administration of syntometrine. It is well documented in the research that syntometrine can lead to an increase incidence of retained placenta.

For my second delivery I chose to have a natural 3rd stage providing the labour went well with syntometrine on standby should I need it. The delivery went very well, 2.5hrs in total and a natural 3rd stage. No pph, cannot believe how much better I felt post-delivery. Hope it all goes well for you. AIMS (association for improvements in medical services) do an excellent booklet about the 3rd stage of labour looking at the research and rationale between a managed or physiological 3rd stage.

I had PPH with both births but although I lost more blood the second time round I wasn't as badly affected by it. I think what made a difference was the following

1. Midwife prescibe iron tablet to make sure my iron levels were tip top before birth

2. I knew the second time round what to expect and how it would be handled - makes it much less scarey when you know it's under control

3. I didn't have an epidural the 2 nd time round which I think added to my low blood pressure and general all round feeling shite after ds1.

gummy... the injection is related to an increased liklihood of retained placenta; effectively the unnaturally sudden contraction of the uterus can 'trap' the tail end of the placenta and tear it.

In my case my uterus naturally contracts well so the injection probably caused far too fast a reaction and I am convinced was responsible for the resulting illness and PPH.

But I also agree with Connor... second time round, especially if you've had a rough ride first time, you're far better mentally prepared. With dd i had a very similar attitue to most first time mothers; thinking that all those horror stories 'happen to other women' and expecting a lovely all natural birth... dd and my body had other ideas!

Nancy were you told they didn't know the reason or is it just vague? After my pph with DD2 9 months ago I didn't really have a clue what had happened and it wasn't until my 6 week check with consultant that it was explained.

Second stage labour 9 mins, 9lbs 6oz baby, no tearing whatsoever, gas and air (no time for anything else), third stage (natural) 7 mins and very large placenta so they think that pph (3.5litres so thats about 6 pints-ish I think) was caused by an atonic uterus so sounds like yours, wouldn't contract properly or fast enough.

I remember getting wheeled to theatre and a doctor saying to me "no more babies for you" as they were about to put me under.

BUT having spoke with the consultant and my mum being a midwife it is a risk of happening again but they would scan me regularly towards the end to watch growth and then possibly induce me early. They would manage the 3rd stage and they also said that I shouldn't think of it as a huge risk that I would rule out any more children.

If you have any questions you can ask for a debriefing (is that what its called?) with your consultant who will discuss your notes with you.

HTH