Advised against a homebirth due to previous (minor - 500ml) pph...?

[marthamay]

Hello,
I was wondering if anyone had any thoughts on this.
Yesterday I had my booking in app for my 2nd pregnancy. When I mentioned wanting to have a home birth the midwife was initially very supportive but then when she went and checked my previous birth notes she noted that I had had 'complications': failed ventouse followed by forcep delivery and episiotomy. It was also noted that I had a post partum haemmorage (spel?) and lost 500mL of blood and my blood count went down to 8. I didn't need a transfusion thankfully and felt fine within a few days.
The midwife led me to believe that this was a very serious complication and that I would now be considered 'high risk' and therefore would need to be under obstetric consultant care and really gave me the serious doom and gloom about it all.
I have to admit that I was a little shocked and got quite upset. I found my first birth incredibly traumatic. I am actually quite terrified about the prospect of going back into hospital for my second birth. What really upsets me is that mistakes that I felt were made in my care the first time around (that I strongly feel led to the assisted delivery and pph) are still reverberating so strongly in my life to the point where they are going to control how I have my 2nd birth!!!!

When I came home yesterday I started looking into pph and have discovered that 500mL is the minimum amount that can be classed as a pph - so maybe my midwife was being a little alarmist???(or is this completely naive of me?)

So anyway, I've got a long way to go yet and am trying not to let the whole thing make me anxious. I just want to do as much research as possible into the matter and try and to make an informed decision.

I guess I'd like to know if anyone has had a similar experience or has done any research of their own into this matter - or if anyone has gone on to have a homebirth after a previous pph?

Also wondering if I do decide to ask for a homebirth, how do I stay strong in my decision if people (mw and consultant) advise me otherwise?

Sorry for long and rambling post, my head is all over the place!

"These things do kill. Even in a low risk pg"

Sorry for what happened to your dd LF

I still think the OP can be assured that overall - despite a PPH rate of 4% for low risk pregnancies, the maternal and infant mortality rate for women having planned homebirths is no greater than for women birthing in hospital. Which is why midwives are happy to do them.

The key issue is whether a previous PPH of only 500 ml (which wouldn't be categorised as a PPH in France - it has to be more than 500 mls) puts the OP at increased risk of another PPH.

"I think that's what OP needs to know, if MWs at a homebirth would have time to assess the situation"

I dont' think anyone can reassure the OP on this score.

There is always the chance of a sudden, catastrophic event at a birth - a severe shoulder dystocia, a cord prolapse, a placental abruption, a uterine rupture. These things do happen.

But despite all this - overall homebirths appear to be no more risky for healthy mothers.

I still think the key issue for the OP is to ascertain whether her previous birth puts her at higher risk of another PPH.

LF - sorry to hear of your loss x

Hello everybody. Haven't got a chance to respond to any of your posts just yet, I have relatives here today and it's quite chaotic! I just wanted to say to lunaticfringe that I'm so desperately sorry for your loss - your first post wasn't inappropriate at all and thank you for being honest and telling me your story. I hope you have people around tonight (if you want them there) and can look after yourself completely.
I'm really sorry to anyone who has lived through a terrible or life-threatening/life-changing pph and I can see how my post might seem a little flippant or naive from that perspective. Hearing these stories is very important though and I appreciate it.

LF. so sorry to hear about your awful experiance and loss

The fact is (some) healthy / low risk mums and their "healthy" babies, unfortunately die during childbirth.
and if you are low risk, the chance of both you and baby being alive at the end of the birth is greater if you choose a home birth.

But yes, very sadly, weather in home or in hospital people do die.... and there are some people who choose a home birth and might not have died had they been in hospital. There are also people who die while in hospital, who may well not have died had they been at home and had 100% attention from 2 experienced midwives, rather than maybe sharing 1 newly qualified midwife in hospital.

Also the chances of most complications seem to be lower at home, although PPH has a higher chance of complications at home than other problems, which are normally more likely in a hospital.

Its up to you as the mother to choose which risks you are prepared to take for yourself / your baby. Hind sight is a wonderful thing, and going to hospital is not necessarily a better or safer option.

Just to add another story to the mix:

I had two pphs, the first in hospital about 2 hrs after giving birth. I was lying down and begun to feel shivery and dizzy, then more shivery and dizzy. The bells on my ward weren't working. The next thing I remember is the woman from the bed next to mine standing there with a ward assistant who told me off because there was blood dripping onto the floor. I tried to get up, collapsed, and the ward assistant shouted at me and walked off. I went home the next day, feeling terrible, barely able to walk, and the day after that called out-of-hours because I was finding it hard to breathe. Our lovely GP came straight out to me, and it turned out that my hb was down to 6 and I'd lost about 2000ml. I refused to go back to hospital for a transfusion because I didn't believe I would be safe there. It took weeks and weeks to recover.

Next time, home birth (different area, I didn't tell them about the first pph), it happened again, 2 hrs after giving birth. I was in the bath, one of the midwives sitting next to me. Felt shivery and dizzy. She got me out of the bath, took my bp, and called an ambulance. Felt worse, passed out on the bathroom floor. Next thing I remember is being in hosp with tubes in my arm, having lost 2l of blood. Discharged next morning, felt well in a week.

So I had better, safer care at home, a good 45 mins from the nearest hospital, than I did on the post-natal ward about 100metres from A and E. If I ever do it again, I'm staying at home again, knowing that I will probably haemorrhage again. My experience is that it's safer.