compund presentation, bad tearing and PPH first time, I couldn't be that unlucky again, could I?

[ellangirl]

Had a great labour with my DS, woke at 5 with first contraction, in established labour by about 7am, born at 1pm after 1 1/2 hours of pushing BUT he came out with his elbow next to his head which had caused a lot of internal tearing, and I had a PPH requiring blood transfusion. They didn't know he was coming out this way, just thought I was being feeble about pushing, but it's a wonder the damage wasn't worse considering the elbow plus head on 98th centile!!

Had booking in appt with midwife and she told me i had an increased risk of having a another PPH and might well tear badly again. Could i be so unlucky as to have another baby present like this? If not, is there any reason i should tear badly again? If anyone has any stories about straightforward second births after these sorts of complications in the first birth I would be really happy!

You've no more chance than anyone else of tearing again but if you do, it's more likely to be a bad tear.

Someone on the Homebirth Yahoo group put up some stats on PPH yesterday. Apparently you have a 5% chance of PPH if you've not had one before. If you have, the risk of another one is 15% - so 85% chance of not having one.

I had a 3a tear, forceps, PPH and retained placenta in hospital following induction first time round. I am hoping for a homebirth this time round - any week now please baby!

The midwife told me I would be strongly advised against a homebirth this time, but in truth it's not for me anyway. I was quite proud of myself after birth the first time, and just objected to her putting the fear into me already! Are you more likely to tear badly if it happens because of the scar tissue? I take it this is something you've looked into a lot because you want a homebirth this time. Good luck for the impending birth by the way, a beautiful spring baby!

Amongst other complications with DC1's birth I had bad 2nd degree tears & a massive PPH. DS was small but posterior. I think the presentation had a lot to do with the tears. With DC2 I was advised to give birth in a teaching hospital due to the PPH risk which I was quite happy with after previous experience (despite the fact some of the issues probably could have been avoided by a better approach). This time DS2 was large (9.5lb), facing sidewards to start with, as in between forward and posterior. I had a long labour under epidural & no tearing at all to my relief, but another PPH despite all the precautions, still big enough to require transfusions.

I had done no prep like perineal massage. I think a large part of it is down to luck & getting the right combination of all the various circumstances. May be the risk of tearing is slightly reduced with subsequent deliveries due to everything being stretchier having been through the process before? Check you are not at a known increased risk of PPH due to blood clotting disorders or gynae things like fibroids & inform yourself on what they might do to prevent one again. If you are particularly anxious about the presentation maybe you could ask for a late scan? But I don't know if that would actually tell you anything, as the baby can still move around a hell of a lot even during labour!

ellangirl I've done almost nothing but obsessively research it since DD was born

Sent too soon! I think that yes, it is down to weakness in the old scar - it just tears along or next to the old wound again.

Best of luck to you too, i shall try to remember to give a damage report after!

That would be very useful, flisspaps thanks. I'm sure your research will stand you in good stead

idlevice as far as I know the only reason for my pph was trauma to the tissues. If you had no tearing, why did you still bleed so much second time around? We're obviously just bleeders!! The midwife talked about making sure my next delivery is controlled and providing support to perineum, but the thing is the first one was controlled delivery, except he came out in one go because obviously the head and arm were out together. The damage was all internal so I always presumed it was down to the elbow. I only had 2 stitches externally. I suppose I'll not worry too much about it and hope for the best!!