post partum haemorrhage

[owainsmum]

Does anyone know whether there is increased risk of haemorrhage if you had one for a previous birth? I'm not planning to have another baby quite yet, but had a very severe blood loss after my son was born, and lost over 7 litres. I think if I have another baby I'll seriuosly consider an elective c section, given my past experience I'm sure that will be allowed, but I was wondering if it's likely to happen again if I went for a natural delivery.

owainsmum I'm not a medic but I also had a very severe delayed PPH after my second child was born and lost the same amount of blood as you. I've had six more children since then, all natural births, but bleeding has been a problem with all of them, though not nearly fatal like that first PPH.

I did have another very serious loss with a miscarriage though, but there's no planning that you can do to avoid that particular risk except sprint asap to hospital at the first sign of anything wrong.

I'd definitely talk to a consultant.

Yes, unfortunately there is a high risk that you might bleed again, although it may not be as bad as last time. Generally people bleed more after caesarean sections but in some unusual cases an elective section may be appropriate, it depends exactly what happened last time. It must have been horribly scary for you, if I were you I would see if you could ask your gp to refer you for a pre conceptual appointment with an obstetrician to discuss it, if that isn't possible see if you can go over your notes with a supervisor of midwives or a birth afterthoughts service.

I think it depends on the reasons for the pph. I would agree with maxbear, it might be useful/helpful for you to debrief your birth. The standard answer you'll receive is, yes, you are at increased risk of bleeding again and if you were to get pregnant again you would probably be automatically classed as high risk. But you may not actually be high risk, if your pregnancy and birth were different.

I had a massive pph & transfusion with my first and barely bled at all with my second, the midwife wrote down 100ml as she had to write something. I had a long letter from my consultant after the first birth stating what the reasons were in her opinion (I probably could have had an appointment but we'd moved). The reasons were circumstantial and no more likely to re-occur for me than for anyone else, so I ended up booked in under midwife rather than consultant care and had a natural birth second time.

I am sorry you went through that, it's horrible.

I had no haemorrhage with my 1st but a reasonably nasty one with my 2nd - not as bad as yours though, no wonder you're frightened.

I'm pregnant again and one of the first things I asked my consultant was whether it'll happen again - my husband is particularly worried about it. She said that reasons vary for haemorrhages and mine was probably due to the induction and that my daughter was very big, and that it might happen again as I will probably have to be induced again and there's no reason to think this baby'll be much smaller than my other two were. However, she was very reassuring and said that they'll be completely prepared this time, and will make sure I have a canula in for instant access for drugs etc.

It was reassurance I was after really and I am thinking about it a lot less now I know I've flagged it with them and know that they're thinking about it too! Definitely talk to someone about it, before you get pregnant if it'll make you feel better.

I had a pph with my first and 2 transfusions. My consultant warned that I was at risk of another pph when I was pregnant the second time. I had an extremely traumatic birth the first time and so I was offered an elective c-section. However, he also said that I was not being offered the c-sec on the grounds of the pph, but because of all the other complications that I experienced. He said that my chances of hemorrhaging in a c-sec were higher than hemorrhaging again in a natural birth which was one of the reasons that I eventually opted not to have a c-sec.

I did loose a lot of blood the second time too, but only half of what I lost the first time and as they knew my history, they had a drip ready which I was put onto immediately and so I avoided having to have transfusions. I wouldn't say it was a great experience, but far far better than the first time.

I had one with my first dd and needed a transfusion and also needed one with dd2, it was really bad as I had a homebirth and needed to be blue lighted to hospital.

There can be alot of reasons for a pph - it is a complication that CANNOT be predicted beforehand. Yes, there is a chance that you may have another pph. BUT you would have a higher risk of it with an elective cs!! Also your blood loss was probably 700mls not L as the human body's blood volume is only 3L. You should be mindful of your iron levels especially towards the end of pregnancy as this makes a huge difference on how your body will cope with a hard labour & possible pph. i've attended many birhs where the mother can looseup to a litre and still be quite finne - because of adequate nutrition & overall health. You could ask for an active management of the third stage - once baby's shoulders are birthed, they injected you with syntocinon to help expel the placenta & contract the uterus.

OP now I come to think of it that's exactly what they did for all subsequent births: hooked me up to a drip and gave me whatever it's called.

lalilu they gave me 8 bags of blood (there was a problem because they ran out of O neg blood..). They said that was 8 litres so I assumed that's what I lost. I kept having repeated haemmorages though during the transfusion, perhaps OP was the same.

I also lost a lot of blood during dd's birth, and was given 3 bags of blood. Does this mean I lost 3 litres?

I am wondering if you ladies were told or know where the blood comes from when you loose that much? Is it from a cut/tear or from the uterus? placenta?

I still feel very guilty and quite traumatised about the fact I couldn't look after dd properly in the days following her birth, and was too exhausted to bf without formula top-up - bfing never really recovered. I am terrified of it happening again.

sheflies please don't feel guilty. I'm 19 years on and can see how wrong it is to feel guilty. It's taken time. Please don't. Bad luck and for you too, that's all. Just life.

I lost a lot withmy second delivery and it was awful. The birth was amazing up u til that point and i was terrified of it happening again. Unfortunately I had the same issue with my 3rd delivery too :(

However, my fourth delivery last year was absolutely perfect with very minimal blood loss. Am expecting number 5 in 4 weeks and im hoping it wont happen again.

I was given extra support from the consultant and midwives as they were aware of the risks and i had a line in my hand when i went into labour so it was ready if I needed it.

My pph of 1500ml was quite bad but not extreme (I had a transfusion of two units the next day) so I doubt the OP only lost 700ml. I lost 450ml with my second birth and that really wasn't much.

I was a bit worried about having another pph but circumstances of birth were different and it was fine.

lalilu I lost 7.5l with dd2. The human body's volume is actually about 5l & pregnant women can have up to 50% more. Anyway, I was losing blood whilst they were transfusing it into me, so I was probably losing other peoples blood too! I had 13 units of whole blood & numerous others of platelets/plasma etc.

sheflies a bag is a unit I think, which is 1/2 litre. You probably had a 1.5l transfusion, but you may well have lost more.

owainsmum ask to speak to a consultant about your 1st delivery, they'll be able to clarify whether it is likely to be a problem again.

definitely go for a debrief, i lost 3.5L with DD2 and was transfused 2 units and a bag of platelets.

My consultant wanted to see me for my 6 week check and I got a debriefing and think it was definitely useful. My PPH was caused by an atonic uterus, big baby, big placenta and speedy 2nd and 3rd stage, 9 mins and 7 mins. She explained that although i would be high rish if i were to fall pregnant again i'd be monitored throughout pregnancy and have a managed 3rd stage but would not be offered a c section as would be a higher risk.

I don't think the amount of blood transfused is directly linked to blood loss but to do with haemoglobin level. I think they transfuse until you are at safe level. A normal level i believe is 12, mines was always high in pregnancy, after transfusion it was 7.2 but they wouldn't let me leave hospital till it was 8 and was on iron til it was 12.

BUT this is all from memory and from what my mum (my midwife) has filled me in on. Definitely go speak to consultant!

oh and an average human has 5-6l of blood but not everyone is average. The human body is made up of 7% blood so a 2l loss to a 5' size 10 woman can be as serious as a 3.5l loss to a 5'8" size 16 woman (me) so averages don't really work here.

Thanks for all the replies. It was definitely 7 litres, I was losing what they were pumping into me as well as my own blood, then had to have 14 units transfusion plus loads of other blood products and fluids. There were lots of small factors which caused it - long labour, forceps delivery, loads of tearing, uterus didn't shrink afterwards despite managed 3rd stage etc etc. I'll definitely see a consultant when I decide to have another baby, and make sure I've got all the extra support I might need.

I had a 7l PPH too and had about 20 units of various blood products - different cause in that I was septic and hence had clotting problems. The amount you are transfused doesn't necessarily correlate to the amount you've lost.
Statistically, you do have a higher risk of PPH second time around, but this varies according to what the underlying problem was - and this also affects whether an elective section would be a good idea. If you just compare elective section to vaginal delivery, there is a higher risk of PPH but in some situations elective section may be safer - for example I've been told elective section is probably safer because I had an emergency section last time but was septic whilst scar healing so it is probably weaker and hence at greater risk of rupture.
For me personally, I also would really struggle emotionally to go through normal labour after what happened last time and suspect I'd be so terrified it would all go wrong - but that's going to vary for different people.
We are starting to think about trying for a second baby and have just been back to see consultant who looked after me first time around - and was amazing. I do feel happier having done this and knowing what the plan would be so can strongly recommend doing this - even if you are just wanting to think things through.
Good luck and take care.