High risk third stage: what would you do in my situation?

[despair]

Hi, I had planned a natural home (water) birth however due to a fibroid in a slightly awkward position I have increased risk of post partum haemorrhage. This was not diagnosed by the NHS but by a well-known private consultant. He has advised me that a homebirth is out of the question, dito a stand alone birthing centre given that I need full medical back up. Also, he advised that I should not consider a physiological third stage (as I had planned) but a medical third stage (ie managed). He also said that I should be able to have a water birth as long as I have a carefully managed third stage (obviously outside the pool) with full medical back up.
I have discussed this with the person in charge of a birthing centre at a major London teaching hospital and put in my birth plan that I would like to have the third stage carried out by either a senior midwife (who has recent experience with managed third stage in situation where there is a fibroid) or consultant. However, it looks that they will not guarantee that the third stage will be carried out by a senior midwife, basically the view is that the midwife (suppose could be junior) will ask for backup as she sees fit. What would you do in my situation? Shall I let go of the idea of a natural birth and ask to move to the labour ward where at least I will be sure that there is a consultant straight away in case I get into difficulty?

did the consultant but a statistic (percentage risk?) on the chances of the hemorage. And how "bad" a hemorage he would expect for that %? What is the mechanism, why should a fibroid increase your risk of pph?

FWIW, I technically had PPH with my 3rd baby (born at home). Because I lost 1250 ml blood rather than the regulation 500ml. Resulted in trip to hospital but actually I was fine, went home with only an iron tablets prescription as treatment (which i didnt bothr 2 take, either).

i have to say that i would opt for a hospital birth, no discussion, i would not want to risk it.

For me also no discussion, would def go for hospital.
and you can still have a natural birth in hospital can't you?
Best of luck!

I'm sure you'll be bitterly disappointed by not having the birth you planned. However, what's more important is that you do not put yourself under any unnecessary risk. If it were me, I'd opt for the hospital birth. That's the sensible option IMO

despair - midwives are trained in medically managed third stage - much more than physiological I am afraid. I would not have worries about junior midwife. The senior midwife will be hovvering in the background I am sure.

Is the labour ward far away? Ours is just through a set of double doors.

unfortunately many of us do not end up with the birth we expected

just remember it isn't the journey its the end result and for you the end result is a healthy baby and you staying around to be its mother not you taking any risks just so you can have the birth you have so far imagined

I also planned a home birth when I was first pregnant and ended up with 2 elective sections .. you know what .. I really don't regret them or anything about it ..

honestly, truly it will take some adjusting but you have to do what is safest and not take risks .. knowing the percentage risk won't help what if you're in the wrong 20% or however many it is

Go for the labour ward. Don't take any risks. A fibroid caused me to have a bad haemorrhage during labour and I would have died if I hadn't been in hospital at the time.

Mine hadn't been diagnosed before (they don't show up on standard antenatal scans). You are lucky that you know about yours in advance.

Tutti Frutti, I potentially have a choice between the birthing centre (I would be able to use the pool if available for the second stage) and then have managed delivery of third stage out of the water. However, I have asked for reassurance that the third stage would be carried out by a senior midwife (most third stages at the birth centre are physiological i.e. not managed) who has recent experience with managed third stage in situation with awkward fibroid (it is not just the position and size of the fibroid but also the type, there are three types and this is the most awkward one), however, the birthing centre has come back and has said that if a junior midwife feels confident she might do it, i.e. I have no guarantee that it will be carried out by an experienced midwife, although an experienced midwife might be present (or near by) - this really freaks me out, I am having nightmares about it. So alternatively, I could ask to give birth at the labour ward, e.g. no pool and restricted movement because of hospital policy , and timing of stages etc, basically everything I wanted to avoid. I am totally unsure what to do.

See another consultant. Seriously, consultants differ. For instance, had two vert well-respected specialists giving radically different advice when my sister had gestational diabetes that hadn't been picked up until far too late ? from 'caesarean at 38 weeks' to 'wait for her to go into labour naturally and don't worry if she goes over dates'. (She was induced a few days over, as it happened, and it was fine).

It can be really helpful to see how two different consultants approach the same situation.

Best bet is to hope Mears comes back to comment on your post giving more detail on midwives and 3rd stage and then follow her advice.

I have first seen the hospital consultant, he didn't examine me, to be honest he didn't even look at me, he just looked through my notes and the 12 and 20 week scan reports which didn't mention a fibroid and an old scan report from 2002 by another consultant which had identified the fibroid, he then wrote in my notes that it was fine for me to have a homebirth. My GP questioned this at the next antenatal check up because he could feel the fibroid very clearly hence I went to see a private consultant (who happens to be very well known and respected). He did a scan and said that given the position, size and type of fibroid home birth (although he normally supports homebirths and even attends them as an obstetrician) is totally out of the question in my case and he stressed (and wrote in his report) that I have to have a carefully managed medical third stage with full medical back up.

I have first seen the hospital consultant, he didn't examine me, to be honest he didn't even look at me, he just looked through my notes and the 12 and 20 week scan reports which didn't mention a fibroid and an old scan report from 2002 by another consultant which had identified the fibroid, he then wrote in my notes that it was fine for me to have a homebirth. My GP questioned this at the next antenatal check up because he could feel the fibroid very clearly hence I went to see a private consultant (who happens to be very well known and respected). He did a scan and said that given the position, size and type of fibroid home birth (although he normally supports homebirths and even attends them as an obstetrician) is totally out of the question in my case and he stressed (and wrote in his report) that I have to have a carefully managed medical third stage with full medical back up.

Despair, is there a middle way here? Does the labour ward offer any sort of "active birth" rooms or facilities? Many labour wards now will let you, even encourage you, to be fully mobile during labour and some have teams of midwives trained in active birth techniques. So even if they haven't got a pool, this could be almost as good as a birthing centre in some ways.

If you go for the birthing centre, you may be worrying so much during labour about what will happen during the third stage that it could affect your experience of the birth. Personally I would go for the labour ward.

Thanks. All weekend I have been thinking about this and although I had lots of signs of latent labour last week they have now disappeared, I assume because I feel extremely anxious. Today I am trying to go and find out whether it would be possible to try to have an active birth at the labour ward. Thanks for all the advice.

Thanks. All weekend I have been thinking about this and although I had lots of signs of latent labour last week they have now disappeared, I assume because I feel extremely anxious. Today I am trying to go and find out whether it would be possible to try to have an active birth at the labour ward. Thanks for all the advice.

I wouldn't hesitate to plan on a full hospital birth in a labour ward. Not even an issue. NOTHING is worth the risk of uncontrolled bleeding in a non-hospital setting. This is your health we're talking about.