post partum haemorrhage - help needed

[roseyposey]

I have just found this website after trawling the Internet looking for somewhere where I might get some help/advice/support. My story is quite long so please bear with me; I don't know if there are any midwives/health experts who use this site but I'd particularly appreciate your thoughts.

Here goes, deep breath... I had my dd 14 months ago. She was dearly wanted as I suffered a horrendous miscarriage with twins at 20 weeks nearly 3 years ago. I was in a terrible way after the miscarriage, we had to bury the babies in a churchyard, I was in a very very black place in my head, and the only way I could move forward was by focussing on getting pregnant again; I was "rewarded" (and felt I really deserved it)with an easy pregnancy and unplanned homebirth without drugs with my beautiful daughter (unplanned because I didn't realise how advanced my labour was until the m/w came round to examine me and said I was already 10cm). My dd had some meconium in the waters so we had to be transferred to hospital immediately afterwards to have her checked by a paed (she was fine). However it all turned extremely nasty when I started to bleed in the ambulance - not much, but a steady trickle that was enough to make them put the blue light on. I went into shock, felt very numb, was barely aware of my baby being held by the m/w in the ambulance. Once at hospital, I was given a shot of ergometrine (I think) and the midwife started trying to stitch me up, believing the blood was coming from some rather nasty tears I had. But suddenly I felt the blood rush out - the sensation was as if someone had turned a tap on my body (this is very hard for me to write, am feeling a bit shaky). Suddenly there were several more people in the room, trying to stick drips into me. I think I was given syntometrine and something called gelufusion (sorry for sp.) I thought I saw an angel on the ceiling and just focussed on that; my blood pressure had also dropped. All the time my dp was sitting in the corner with my newborn daughter - I didn't even know they were there. He has since told me he was terrified (he won't really talk about it with me now, just says it won't happen again. The poor man also sat beside me as I delivered our dead twin girls). I don't know how long it took to stop the bleeding - not very long, maybe 5-10 minutes - and the consultant started putting her hand inside me - to pull out some clots, I think. There was never a sense of panic, nobody shouted, it all seemed quite calm and "workmanlike", but once the bleeding was under control they had to catheterise me to start stitching me up - at this point I really lost it and started crying and begging them not to put the catheter in as I had had one with the miscarriage and it reminded me of it all; I was given gas and air as well during the stitching. This seemed to take ages. Finally I was able to hold my daughter and put her to the breast for the first time - she was wonderful, latched on straight away. I then had to have a blood transfusion - two units, but it took them over 24 hours to get it to me, by which time I had fainted twice and could barely move out of bed. Teh time I spent in hosp was pretty grim and it was only once I was back home that I really started falling in love with my baby and bonding with her.

The euphoria of it all - finally holding my baby and adoring her beyond belief - lasted for months and it has only been since she was c. 10 months old that I have started thinking about the PPH.

When she was seven weeks old I went to see a consultant to ask about why it had happened. He was actually pretty nasty to me and started banging on about homebirths and how I had lost half my volume of blood (c. 2,500mls, apparently). I asked him about future babies and his words to me were "Have one more and stop there." I sat there crying trying to feed my newborn and felt chastised, humiliated, and as if the wonderful birth (NOT the post-birth stuff) was being denigrated by him. I have since been able to speak to a wonderful local midwife who told me that no-one should ever tell you how many children to have. When I asked her if it would be irresponsible to have another baby, she laughed and said it would be irresponsible not to as I was clearly a good mother (the nicest and most positive thing a health professional has ever said to me). She also said that there was a possibility that being moved so soon after delivery, not putting dd to breast, shock of going into hosp all could have made the uterus de-contract (sorry if wrong word). The m/w who delivered my dd said I had an ATONIC UTERUS, which I understand to be a uterus that fails to contract after the placenta is delivered (btw, I had the injection to get the placenta out).

I really really want to have another baby BUT am petrified of this happening again. When I had my m/c I also had a pph - we thought it was because I retained the placenta and so for my 2nd pregnancy we didn't really consider it might happen again. But the births were both so different - m/c drugged to eyeballs, incl. morphine; dd absolutely nothing except some homeopathy pills to help me cope - that I find it hard to compare my experiences, and indeed one m/w has told me that women do tend to bleed a lot more with m/cs than with normal births.

Please forgive the length/confused nature of all this. It's the first time I've written about it.

So I do want another child - badly. My dd is my passion, I have never experienced anything like it, she has enriched my life beyond belief, and I want to do it all again. Although I am not desperate to get pregnant right now, I would like to start ttc sometime this year (I'm 35 now). My fear is of it all happening again. Everywhere I read about PPH I read things like "leading cause of maternal death worldwide" - I am terrified of dying, leaving my dd and dp and newborn; I am also terrified about the possibility of hysterectomy. I know that when I have another baby I will already have a canula in place with drugs on hand - but what if they don't work?

If there is anyone out there who has had a PPH (or more than one) and then gone on to have a birth without bleeding, please, please do get in touch. At the moment I just need to feel that there is a chance it might NOT happen again (and can anyone tell me if an atonic uterus is always atonic? Is it a problem I will always have? or can any woman get it?) Please, please don't tell me to go and see a consultant! I think they have a skewed perspective, only see births when things go wrong, and I've already had negative input from one. Also, I don't want to know about even worse experiences than mine (women dying/having hysterectomies) - my miscarriage and two PPHs have provided me with enough horror to last me for the rest of my life.

The possibility of hope will really help me move forward. If you have managed to read my jumbled story, thank you, and please do respond if you have anything to help me.

Thank you for reading. I think I need some rescue remedy after writing all that..

Rosie

Rosie - I had a pph after my first baby (inept young doctor, I think, in retrospect; I was a student nurse and I worked with him and I knew it was his first real delivery). I now have five children and had no further problems with bleeding.

I think you need to "shop around" maternity care wise for the next baby - you need to deliver somewhere where you feel looked after and respected and in safe hands. With your history you should be cared for "as though" you might bleed - and everything will be done in advance to prevent it happening, rather than just some toad of a consultant announcing how many children you can have. I am out of touch with uk maternity services now, but there are private midwives and nhs continuining care systems and even doulas who are there just for the woman and to make sure that child birth is the positive and safe experience it should be. Mears or Prepuce (posters on here) and others will be far more knowledgeable about this than me.

Wishing you all the best...

as for that consultant who told you how many kids to have, what a cheek! stuff him! i'd write a letter of complaint.

Roseyposey - what a difficult time -it's brave to write it all down xxx I'm sorry for what's happened.

Just to say I had a pph with my third - 2 litres in a short time. Was awful - was slipping in my blood on the bed. Waited whilst docs faffed about - needed an epidural so the placenta could be all taken out. The anesthetist wasn't there yet so doc said she'd have to do this with no pain relief - I just shouted do what you have to do. I'd been through childbirth & felt conned that there was something even more difficult about to happen. I steeled my self to be strong. Terrible. Luckily the anesthetist arrived & then couldn't site the epidural - I shouted at her to do her job - it was hard to be still as well in all the blood that was coming out. Anyhow once the placenta was out everything was ok. Just a terrifying experience - also for my dh who was there with dd3 thinking the worst.

I had ds4 5 months ago. My doc wrote that I should have an injection as soon as ds4 head was born to start the womb contracting to delivery the placenta to stop a pph. Anyhow just got to the hospital on time & ds4 born 10 mins after I got there! No injection as m/w's no time to get my notes & I didn't know this. All was ok - the placenta came out by doc pulling on cord. No problems - don't know how much blood I lost was classified as pph but no where near that for dd3 - but no problems. I took iron suppliments & was ok.

If you want another little one go for it! Would an elective cs be a solution? Wishing you all the best xxx

rosie, that sounds grim. :( And the consultant sounds like a complete arse tbh.

I had a pph after my first baby - lost 1000-1500ml so nowhere near as bad as yours, but it was also due to an atonic uterus - dh said the blood was pumping out of me at great speed - and nobody ever said that I should limit the number of children I have because of this or anything else.

I actually went on to have two home births and did not have any more problems with bleeding. I think it is just 'one of those things' - I don't know what the statistics are on it happening again. Hopefully one of our resident midwives will come along for more input.

I did think about writing a letter but simply don't have the energy for it - I went through a stage of feeling REALLY ANGRY with him but (sorry to sound all pseudy-psychology here) I think I've worked through all that, got beyond it, can't be bothered with him - BUT I do know that I shall never, ever see him again.
Thanks for responding glimpopo (sp?) - a glimmer of hope for me.

I'm shocked at your experience and impressed with your strength. I don't think you had an irresponsible homebirth. I think you have had very poor medical attention. I would deffo have another lovely baby and I would deffo have it at a different hospital.

I can understand the consultants stern remark if you had insisted on a homebirth against medical advice. But, you didn't exactly plan it. Jerk.

Thank you go geekgrrl and milward - what a relief to know you went on to have more and came out of it all ok. You have all helped me already, just in the 30 minutes I've been sitting here (in pyjamas still). I have been told I can never have another homebirth but that's fine by me - I just want to have drugs on hand if necessary. The toady consultant also said something about giving the injection just after head is out BUT I then read somewhere that this can make uterus contract too soon and you can end up with retained placenta - another nightmare I've already experienced and want to avoid. The problem is, although I'm a reasonably intelligent person I'm not a medical professional so find it hard to DEAL with the info on the Internet, put it into some context.
Thanks again. You're brilliant.
Rosie

Don't know if what I had with my second baby was PPH? I had some retained placenta and bled heavily and so had to go back to the delivery section to have the "products" removed (this was worse than giving birth). They didn't scan me and two weeks later I could feel something inside my vagina (sorry if tmi). The midwife came and thought it was a prolapsed womb. I spent a whole night at home terrified to move, went to the hospital the next day where they discovered it was bits of placenta they had missed.

I don't think having a home birth was the cause of your pph - I had mine after a standard hospital birth and you had the injection - don't see what difference being in hospital would have made (other than being closer to the emergency care you needed).

I went on to have a third normal birth with no pph. The local stand alone birthing unit wouldn't take me because of the risk of having to be transferred to a hospital but I was booked into another birthing centre which was based within a hospital. I didn't actually end up giving birth in the birthing centre because I had to be induced and so had a standard hospital delivery again.

If you do go on to have another baby I would insist that you are looked after by a different consultant to the one you saw after the birth of your dd. As ggglimpopo said, the birth will probably need to be planned to take account of the possibility of bleeding, but unless you have some specific medical condition which means you will definitely bleed, I don't think the risk should be any higher than for anyone else. Hope this helps (and welcome to Mumsnet!)

And I don't know about elective c/s - I think risk of pph is significantly increased with c/s, so would rather not opt for that from start. But yes, I definitely need to get myself under a DIFFERENT consultant and have a very clear action plan. God - I'm not even pregnant yet! But something tells me I need to have all this clear in my head before embarking on another pregnancy, rather than getting there and panicking for nine months.