anyone had a homebirth and needed a blue-light transfer due to bleeding?

[barelyutterly]

Either during labour or after birth, placental bleeding. I'm curious to know what your experience was if you care to share, as I'm trying to make a decision for a homebirth and my own risk for bleeding. I have a low-lying placenta, but far enough away to warrant vaginal birth by RCOG standards, baby's head is now fully descended below the edge of it, and the many academic papers I've read by now all seem to think this is ok for actual labour, though the risk of PPH may be higher.

Have a consultant meeting on Monday to confirm, and my gut feeling is that I'll be ok, but nobody I've seen up til now (midwives, obs) seems to have any experience of this. Probably because everyone in my position is made to have an ELCS by now (I would have if I hadn't insisted on more scans and second opinions) or give birth in the labour ward.

I live less than 5 min away by ambulance from a major London hospital. Midwife unit is right down the hall from labour ward so either option I pick would be a quick transfer, though at the moment I'm still being talked into midwife unit as a "just in case". Just trying to get my head around what might happen and how it would unfold if I am at home and suffer some bleeding due to partial abruption (haven't had any bleeding at all through the pg, otherwise low risk, healthy and fit, baby in a good position).

Hiya,

Not quite the same but might be of some use to you: I nearly had to transfer after my son's home waterbirth. Had heavy bloody show before the birth got underway, and some bleeding during, then once out of the pool the placenta came away and then, when on sofa feeding realised I could still feel quite a lot of blood being lost - had soaked through pad, dressing gown, sofa cushion :) Anyway, at that point they rang the ambulance, very calmly, and got me lying down to have a feel around. Cleared out a few clots and rapidly gave me two shots of the synto to contract the uterus (had a natural third stage up to that point). Ambulance was there in less than a minute (had been passing the end of my road, in a bizarre coincidence) - like you I lived then less than 5 mins from major hospital (Derby Royal). Anyway, by the time the ambulance crew had come in the house the bleeding had slowed, they hung around for five or ten mins to be sure, then went away again :) MWs stayed for quite a while. I felt pretty poorly due to the blood loss but they gave me iron tablets, told me to rest and keep up the fluids, and all was fine. Overall I was very happy with how it was handled and glad not to have to go in, although obviously would have gone without a murmur if needed. Just thought the experience might be useful for you!

OP why would you want to risk it at all ??? Everyone else seems to have the sense to listen to the experts and have an ELCS or deliver in a hospital, doesn't that tell you something ? How is it that you know better than all of those people ?

OnEdge I had the 'sense' to listen to experts at my last birth who demanded that I have the afterbirth injection - and it nearly killed me. The experts are only humans, humans who are trained to be risk averse and have a panel who will judge them if something goes wrong and those panels prefer intervention. It is the OP's body, the OP's choice, and there is nothing wrong with her trying to get information - she has already mentioned she will be discussing with a consultant who will likely have more information on it than the midwives. I highly doubt she's making her choice on MN alone.

OP I had a blue light special at my last homebirth, as I had a severe adverse reaction to the afterbirth injection which eventually resulted in a lot of bleeding (after a lot of other things happened). What happened is they called it in, the paramedics wheeled me out and my husband was with baby in the ambulance and with her the whole time, the midwives met me at hospital, dozens of people in the room and I was tubed up for blood transfusion and antibiotics. If any of the placenta remains (as is possible with an abruption), they'll decide what pain relief you need (though the anethesiologist can override it, mine did much to my gratitude) and you'll be wheeled in for that. It'll likely mean a night or two on the high dependency ward, then a night or two on the normal ward if everything goes well (I was blessed to get out with one night in each).

I was tranferred for PPH, after my BP dropped to 90/60, but no blue light. They sent me home without any treatment.

Have you been on the homebirth.uk email list or website? LOTS of info there to help you make an informed choice.

My friend's sister had an emergency transfer for a retained placenta - for some reason they didn't have enough time to get her prepped for surgical removal & she had to have manual removal which is hideous.

I knew I had a risk of bleeding so had a hospital birth, luckily as I lost half my blood volume. Worst case scenario is bleeding out at half a litre a minute due to the large amounts of bloodflow in the uterus during pregnancy/birth & the size of the ateries (as wide as your little finger). They knew to have blood for transfusion on standby for me beforehand. Maybe that is something you could ask about - having blood crossmatched & ready to go at the time you are in labour, as that would be extra reassuring if you still do the homebirth.

Barelyutterly I had an unplanned homebirth with DC2. DC1 was a very long and assisted delivery, where I had a pph of 1000mls. I had no idea if the bleed was due to the assistance/length of labour or just "me". I can now safely say it is just me!
With my homebirth, the paramedics (sent by hosp who dh was on the phone to) arrived 10 mins before I delivered. I then started bleeding (total bloodloss estimated at 800mls this time), they were just getting ready to transfer me by blue light when the midwife arrived with the synto - fortunately this worked, and everything calmed down a lot. I then got transferred in around 1hr 30 mins after delivery. They would have liked me to stay in overnight - but I felt fine so didnt.

I dont know anything about placenta problems, so as another person has said you would need to consider what implications this could carry. With regards to bloodloss obv having a midwife there would be appropriate!

OnEdge fwiw, some of us just cant trust the professionals after a hideous experience or just ill judged decisions. Everyone has the right to look at the risk and try and make their own conclusion. My unplanned homebirth was the best thing I ever did, it really was.

Not a home birth but I had a friend who had a massive pph. The injection didn't work and she had to have emergency surgery that saved her life. She lost 7 pints of blood and she was tiny so pretty much all replaced. She was in intensive care for 3 days. I visited her in hospital after a week and she was apparently much better by then but still looked very ill to me :(. It was horrific and very unlikely she would have survived a transfer to hospital. Up until then pg and birth had been textbook perfect. I think in a lot of ways the experience was worse for her dh than it was for her. She was not really with it at the time. The horror of it all was clear on his face for a long time though.

To be fair this kind of thing is rare. Most people will respond to the injection to bring bleeding under control.

My wife gave birth in a pool at home last week. The placenta came quite quite quickly after the baby and she started bleeding quite heavily but thtwo midwives we had here were amazing, they gave her a quick jab of something I can't remember the name of that's supposed to help stop the bleeding and it worked a treat. We're also just down the road from a hospital which felt reassuring. I know there are plenty of arguements both ways but having a home birth felt like the most natural beautiful thing in the world for us. My wife who is very petite and a big panicker was totally relaxed. She didn't need any pain relief at all and gave birth to a lovely 7lb2oz girl. I think she actually felt much safer at home. Plus, our hospital (Queen Charlotte's) have a special home birth team who come and see you every week and are amazing. But yep, lots of blood but no blue lights.

I had a blue light transfer from a rural birthing centre 20mins from hospital. 3 litre PPH and definitely life threatening. The ambulance wouldn't even move me from the floor until they'd squeezed in a litre of saline because they couldn't find a blood pressure. I was low risk, no problems in pregnancy and had a normal delivery with no other complications. My PPH could not have been predicted but this time I will be in a mw lead unit at hospital - there's no way I would risk leaving my kids without a mummy or my DH with 2 babies to bring up on his own.

As Mouseanon says, the impact on my DH helplessly having to watch me go through that while holding his new DD stayed with him for a long time.

If you are being advised to go to hospital it's not worth risking your life or that of your baby to stay at home. Things can go wrong very quickly.

Thanks everyone for the replies. I'm obviously not trying to risk myself or my baby, it's more that I've been given a lot of contradictory information over the past few weeks making it hard to determine the real risk. And as the scans have shown the low placenta to be less and less low (went from "you must have ELCS" 4 weeks ago to "you're discharged back to midwife care now" 2 weeks ago I don't think the placenta has actually "moved" more than the scans have been more accurate) I'm trying to decide if a quiet intimate homebirth is a better option for me all around than a birth in the very busy midwife unit of our local hospital. I would be much happier and more relaxed at home, and I believe much more in tune with my body too. However I only want this if I wil get midwives who are as relaxed about it as I will be I don't want nervous ones hovering over me, believing something is bound to go wrong.

I have done tons of research and reading, everything from medical journals and RCOG guidelines and papers to obs/gyn mailing lists to midwife forums to MN. The risk of the placenta tearing during labour is pretty minimal now from what I understand.

Consultant appt is tomorrow. In my experience, it's the actions of HCP I have learned to trust more than the words they say -- they say lots of stuff about what they want you to do, but when pushed to carry it through, they tend to back down if they know that what they're advocating isn't actually required.

If I'd meekly obeyed the first person who towered over me with scary words and not questioned whether it was really necessary, I'd have had an ELCS weeks ago! Which I now know wouldn't have been necessary at all. So if my consultant tomorrow basically refuses to back down and ok a homebirth then I'll know that he really does consider the risk to be too high, and isn't just going by hospital policy or whatever. So that will be a major factor in my decision.

I was in more or less the same position. I went from needing a CS at 36 week scan to the placenta has moved a few mm so was discharged from consultant care at 38 weeks. The registrar when asked thought the MLU at the hospital would be better but didn't seem that bothered so I went back to having a homebirth. The midwives were generally fine but my birthing midwife commented that a placenta having moved 0.5cm wasn't much. They were happy they could get a cannula and fluids in quickly if necessary. I lived 30 minutes from the hospital and did end up having blue light transfer but not for PPH just meconium in waters.

Hi barelyutterly, we met on the Leboyer thread! I do think you are right to have pushed and questioned all the way through, and I am sure your research will have stood you in good stead. The only thing I can offer you that you might not already appreciate is how much a placenta bleeds & how quickly. A huge amount and very very quickly. 1 pint of blood goes through the placenta every minute, so you can do the maths! I have never experienced anything like it, the first time I had a big bleed it came gushing out soaking through everything, so so fast.

I know that your pp is less severe than mine was (grade 4) but heavy bleeding is not unknown with grade 1/2 (there is a mumsnetter out there somewhere whose pp wasn't even touching the cervix but still had heavy heavy bleeding).

In risk terms the probability is reasonably low, but the risks are very high. Do consider the MLBU.

Just wanted to follow up my story for anyone who finds this thread in the future (or who was following it now -- and thanks to those who responded before).

Sadly my situation ended up with pretty much everything going wrong that could have, the classic intervention rollercoaster, though the irony was that I don't think the low-lying placenta was the cause of any of it, even though it definitely affected the treatment I got.

My hindwaters broke at 4am (Tuesday) at 40+1, with a small amount of bright red blood as well. Because of this, we went to the labour ward immediately, I was admitted, found to be 2cm and recommended to start antibiotics and induction right away. Both of which I declined initially preferring to wait for things to start on their own -- latent labour had begun already with mild contractions about 7min apart. Stayed the following day til midnight without much progress, very stressed due to the situation and how long it took to see anyone (cons and their teams took forever to see us), being cooped up in a labour room surrounded by other women in other rooms sounding like they were in hard labour. Finally discharged myself so I could go home and get some sleep, agreed to come back the next day for monitoring and more discussion.

Next day I saw my own cons who said he was fine with the very low infection risk but that because I still had a lot of forewaters (head was still high), cord prolapse was a concern and he wanted me to stay overnight. I did so this time, agreed to give it another 24 hours before induction and hoped for the best. Next day (Thurs) still not much progress, contractions getting slightly stronger but that's it. They broke my waters, had a moment when the midwife thought that the baby's hand was the cord (to be fair, she was pretty sure it wasn't, but it caused a major panic anyway). I was left to walk around for a few hours and see if I could get things going. Never really managed to do that, didn't get beyond 3cm and 3-4min mild contractions before finally giving in to the syntocinon drip early that evening.

The drip started ok and I thought I could manage without much pain relief (BIG MISTAKE), we got to 60ml/hr within 2 hours without much increase in contraction pain but also no more dilation. The cons came in and said "you have 2 more hours to get to at least 5cm" and left, cranking the drip up to 90ml/hr dose. Within 10 min I realised I was in big trouble without an epidural ready to go and upon finding out that an EMCS had all the anaesthetists busy and it would be 90 min before I could get one, I embarked on the worst 2 hours of my life. On the plus side I did get from 3cm to to 8cm in those 2 hours, on the minus side, without pain relief I was completely shattered and absolutely furious! The pain was so intense words cannot describe it.

At this point I finally got a mobile epidural which helped a lot, I managed to get to 10cm over the next couple of hours and got a much needed break from the stress and pain. Then was told to relax for an hour and "wait to push" despite starting to feel extreme urges to push. The top-up was wearing off so I asked for a half-dose more, thinking I still had lots of time for the pushing urge to come back... instead I was given 1 more hour to get the baby out. In the end I couldn't do it, she never got out of the pelvis and was slightly turned sideways and I had a choice between ventouse (and c-section if that failed) or just straight c-section. I chose the latter as I had lost all hope and at least I knew a c-section like this would be less emergency and more relaxed than one following a failed ventouse. Lived through another hour of hell as my baby was delivered, I felt completely empty and detached, hemorrhaged a bit due to the c-section, threw up from the injection of oxytocin, and didn't manage to hold my baby skin to skin for nearly 40 min after she was born. Thankfully my partner did a stellar job with her and with me and kept it all together. And all through this, not once was the baby in distress, she was absolutely fine from the second my waters broke 3 long days ago til she came out. 1-min Apgar score was 9, 5-min was 10.

So I'm now recovering from a c-section, but wondering if I could ever have birthed this baby naturally, or if the induction and associated stress was to blame for it. Baby is great, due to my fitness I'm recovering pretty well and was discharged after 48 hours from postnatal. I'm not angry anymore, just disappointed, but that's life. Sometimes you gamble and lose. Don't regret any decisions I made except maybe that I didn't start to push when I felt the urge to, and instead listened to the midwife to hold off. It was so frustrating to be told to push under a stressful time limit and just not be able to push hard enough.

Anyway, in the end my placenta was fine, it may have been that it was somehow keeping the baby from turning or getting out properly, or the placenta may have had nothing to do with that. I'll eventually pay to get a copy of all my notes so I can read through them and see if that sheds any light. Really wish my waters hadn't broken as they had so I could have given natural birth a real go, but who knows, maybe I would have failed to progress there as well.

Next time I'm hoping for homebirth VBAC, at least I know they can't induce me!

Hope this helps anyone who reads it. I know I've been helped by the many women who have shared their stories on Mumsnet so wanted to give my own story some closure.

Hi barelyutterly, thank you for updating your story, I had been wondering how you were getting on. Congratulations on your new baby!

I'm sorry you had a difficult time, I certainly relate to the feelings of detachment, I couldn't hold dd1 for an hour or so after her birth & it was probably 48hrs with dd2. I'm so sorry you feel disappointed, I can only repeat what I said on the other thread, birth isn't an achievement, or a failure or a disappointment, IMO, it just is what it is, it is an event. But it has taken me a long time to really feel that myself, so I don't mean to sound preachy.

Ask to go through your notes with a midwife or consultant (our hosp has a specially trained midwife, yours might have similar service). It might help to get professional responses/explanations for what happened.

I'm sure you are making up for that initial lack of skin to skin now, I barely put dd1 down for the first month! Give yourself lots of time & space to process (I know, not easy with a tiny baby) and I hope that soon your disappointment will fade. All the best.

TheFowl, thanks for your help on this thread. Truth is, I'm not disappointed really (much too analytical a personality for that I think) just sort of curious as to what "went wrong" and whether things could have been different. Hence the birth debrief and all that.

I think I needed to detach during the actual c-section because I was just so angry and frustrated in those moments that things had turned out so far from what I thought could be, and my analytical mind was admitting "defeat". But within an hour, once I was in the recovery room and feeding my new baby, I was already starting to be more philosophical about it and move forwards to meeting new challenges. Things have steadily improved ever since and we've had no bonding problems at all.

Ultimately, while I tend to make decisions based on my best information with a lot of gut feeing thrown in, I mostly believe that things happen for a reason. When I consider some of the worse options (failed ventouse, severe tearing, etc.) that could have happened, I can't really complain that I ended up with a c-section that I'm recovering well from. It is what it is, and was maybe the best case scenario given what I know now. So in that sense, things happened as they should have.

If I were a bit younger this experience might have spurred me on to become an obs or midwife... the unpredictability of childbirth is quite fascinating. But alas.

Believe me, after 8 weeks in a maternity hospital I thought I was an obstetrician! I went through the idea of retraining (you're never too old!) but the urge faded after a while. As you say, other things take over.

I hope you are having a wonderful time with your baby, my 'baby' has just moved into a big girl's bed - hard to believe. It's a grizzly old cliche, but it really does go so quickly!

hi barelyutterly i can totally relate to your last post = i had an emcs and felt totally defeated on the operating table. like you, within an hour, i was feeding my new baby nad was quite happy. next morning enjoyed a nice breakfast too as was starving and was looking forward to hanging out and caring for my gorgeous new baby. discharged myself early as was genuinely on the mend and wanted to be at home.

i had done a lot of prepartation and ds was brow presentation. he was starting to be very distressed (heartbeat not recoverying quick enough) and i have gone through the labour with a fine tooth comb wondering at what point he put his head in that position. he was very bruised and a bit swollen where he was getting stuck so i have no doubt the c section was needed. i just wonder if something could have helped him earlier on, something i didn't know about or the midwives/system in general didn't try...

i was generally fine but but on one level utterly gutted as it seemed to be such a slap in the face so i spent an afternoon a few weeks later sobbing into my ipod. after that, i felt a lot lighter!