Looking for some advice Re. previous PPH

[goingeversoslowlymad]

I wanted some advice regarding a previous post partum heamorrage I had with my last child three years ago. I had a pretty straightforward homebirth, however 12hrs later I got up to use the toilet and suffered a PPH. My blood loss was classified on my notes as 2 litres. When I was in hospital getting a blood transfusion quite few Dr's and nurses commented that I would never be able to have another HB.

We are now wanting to ttc number 3 and I am pretty much OK with going into hospital to give birth as I know my DH wouldn't feel comfortable with a HB as he was very traumatised after seeing what happened to me last time (I can't remember a thing). My biggest worry is that I will be immediately classified as high risk and bullied talked into having a highly managed birth.

I would like to labour naturally in water possibly under caseload midwifery. Will this be impossible, or will I have a fight on my hands to achieve what want? Am I being irresponsible to want this and should I just go with what they tell me? Has anyone had a PPH and then gone on to have no complications the next time?

Ok, first things first. Do you know why you had the PPH? Was it an atonic uterus when it relaxed? Was there any retained tissue? Was there an undiagnosed tear? Was the baby very big? Did you have a prolonged labour?
If you are happy to go to the hospital to give birth then you assuaging the first fear - that treatment might be delayed. The most likely plan they will put forward is that you have a cannula sited in labour because it can be difficult to find a good vein with a sudden, large PPH. You could argue they could site one at the first (if any) signs of a repeat.
Next, you will probably be encouraged to have a managed 3rd stage ie Syntometrine injection. Again you could agree to have it if there are concerns rather than immediately.
You might be offered a prophylactic syntocinon infusion for a few hours post birth to keep the uterus well contracted. That's something more proactive and an intervention too far for some people.
Labouring in water may give the risk managers palpitations but if all is going smoothly no reason to be refused. You may be advised to come out for the placenta.
Plenty women who have had a PPH previously go on to have completely trouble free births the next time. In practice I most commonly see women accept the cannula and syntometrine and wait and see for anything else. In your case I would probably do that myself. If you demonstrate you are aware of the risks and are open to management at the first sign of any problem then you are in a strong position.

They put it down to to two factors, the first one being that my Hb level was 9.5 a few days before labour, apparently far too low to have had a HB. Nobody mentioned this at the time as being a problem, was just told to double my iron tablets. The second factor they attributed it to was that DC2 was 9lbs 3ozs (a pound and 3ozs heavier than DC1 who was 8lbs). I also had a natural third stage.

I am happy to have a managed third stage and also to get out of pool to deliver the placenta. I had already figured that they would ask me to do this. Not too sure about having a cannula sited immediately and will probably question this but will agree if it thats what it takes. Thanks for your advice.

No problem. Lots of women find cannulas really uncomfortable but I have a fair amount of personal experience with them and they don't bother me so that's why I would be quite blase about one for me.
If you are not keen then you can ask them to have a tray with all the bits and pieces in a handy cupboard, out of sight! Good practice is to be prepared to put one in quickly if concerns are raised and I've never failed yet. No reason to think your midwives would be any less risk aware but intervention averse.

Hi

I don't really have advice as such but I had a PPH and needed a blood transfusion with my 1st baby. Like you I couldn't remember the birth and my OH was traumatised from witnessing everything.

When I was pregnant with my 2nd baby I was very apprehensive about the birth and spoke to my midwife about all of my concerns. My OH wanted me to have a c-section; however this is not what I wanted or what was recommended etc. My OH and I arranged a meeting with a senior nurse at the hospital (supported by my midwife) and we spoke about everything which had happened in my previous delivery. From looking at my notes she told me that I had low platelet levels and that this had caused problems with the birth. This reassured me as she told me that when I went into labour I was to tell them about the previous problems; platelet levels etc.

To cut a long story short- my 2nd labour was completely normal. Staff did sort out a cannula straight away but this reassured me. They were also highly sensitive to the fear from the 1st birth and I felt really supported and safe.

Talking to my midwife and raising all of these problems really helped me. I was panicking at the thought of going through another birth like the first one but the advice and support which I received once I had explained all my fears was fantastic. I truly believe this helped me.

Good luck, sorry for the rant

mumof3 thanks for sharing your experience. Was wondering were you on the monitor for long periods of time and were you able to move around freely if you wanted.

Am absolutely terrified of being strapped to a monitor for most of my labour like I was with my 1st. Ended up with an epidural and then a 3rd degree tear which had to be stitched in theatre. This is why I opted for the HB last time. I want a very natural hands off birth if I am permitted can.

Hi going

With my second labour I had the monitor which they clip on to the babies head instead of being strapped to the machine (not sure of the proper name). This was much better as they could still make sure baby was fine but I was able to move around as much as I wanted. I think this really helped as I was able to walk around and use the gym ball thing and my labour was a lot easier to manage. I had the epidural with my first labour but with my second I used gas and air alone.

Hope this helps