Planning second pregnancy after previous PPH- ELCS or natural birth?

[teachertrainer80]

Just that really. DC1 7 months and was always the plan to have children close together but after a bad experience giving birth (several sweeps, 30-odd hours of labour, pph of 1500ml, episiotomy, 4 hour pushing stage, painful sex for months afterwards...) Want to think about DC2 this summer but really scared about giving birth again. One friend who had a similar experience pushed for an ELCS second time round and another friend went completely the other way and had a much easier quick natural birth. I really want the latter but think an ELCS would be more sensible.

What have others done? I did hypnobirthing, daily yoga etc the first time round and was really prepared for a calm easy birth but didn't go to plan!

You could still have a PPH with a section. I'd discuss it with your consultant, research it and come to a decision. 2nd labours are traditionally quicker and more straightforward, however there are exceptions to every rule as I'm sure you know. The other thing to consider is recovery from a section with a young toddler to look after as well. Good luck.

Thanks for the reply. I know that you can still have a PPH with a section but it seems so hard to find statistics that distinguish between ELCS and EMCS. I would guess that a ELCS is pretty safe due to the controlled environment but EMCSs scew the stats. It's so hard as research always seems to be biased!

The whole thing about second labours being quicker makes me err on the side of going for natural birth again and I managed pretty well without pain relief and feel that I could manage the pain side of things again. I would probably go for no intervention at all. No sweeps etc which probably sped things up when my body wasn't ready.

Good point about CS recovery and a toddler too. Not appealing!

I had a quite big PPH of 1500ml with DS. Needed to be sewn up in theatre afterwards and had blood transfusion the next day. I think it was partly due to forceps delivery due to low heart rate. I pushed badly for about two hours and overall it wasn't great.

With DD I never considered an ELCS - and her birth was loads better. I still lost about 450ml of blood but didn't need any stitches afterwards. As DS was 22 months when she was born am glad I didn't have an ELCS tbh.

Have you been told if you are likely to have PPH again?
I've just had a PPH during a section and lost 1.6lL.It was a horrible experience but I'm glad I was already on the table or it would have been more.If someone told me I was likely to have another one in a subsequent pregnancy it might sway my decision.

Sorry you both experienced PPH too Miranda and Beatrix. It really is an awful experience. Out of interest Beatrix, was yours EMCS or ELCS.

Good to hear that the second birth went better for you Miranda as we will be looking at a similar age gap. Am definitely erring on the side of natural birth but when I serached for similar threads all the advice seemed to be about doing hypnobirthing etc the second time round and I already did that....I couldn't breathe my way out of the PPH sadly! I think it helped manage pain though although you never know....

Beatrix I was given no follow up about why the PPH happened other than my uterus struggled to contract after long labour. Didn't ask if it was likely again.

Mine was ELCS..it was my 3rd ELCS actually,placenta was posterior and low and vascular and uterus didn't contract as expected when removed.It wasn't related to having previous sections and I was advised if ever pregnant again that ELCS would be necessary..but def stopping at 3!

I had a 3litre PPH with DS1 & for DC2 I was advised that a PPH is actually more likely with a CS due to the fact there is no natural component of the uterus & blood vessels contracting themselves, nor release of blood clotting substances as part of the delivery process. I was strongly advised to give birth on a delivery ward rather than birth centre/home birth, which was fine by me. I ended up with "only" a 1litre PPH after DS2.

Idlevice very interested you were told that CS increased the incidence of post partum haemorrhage.

Listed under the heading 'May be reduced by caesarean section' in the latest NICE Caesarean guideline is....you guessed it....early post partum haemorrhage.

You just can't trust what you are told -anything to persuade women to go for vaginal birth and save the few extra pounds spent on a caesarean section!

Not everything is a conspiracy Ushy!

I wasn't in the UK when I was given that advice. Not sure why it would be different in different countries from a medical point of view, but could be different policies. Maybe those NICE guidelines aren't specific to a subsequent pregnancy after already having had a previous PPH? (as for that case you are already at a higher risk for subsequent PPH regardless of delivery method so that could outweigh what those NICE guidelines were referring to)

I had a 1 litre PPH with my first and went on to have 3 more natural deliveries with no PPH's. The hospital did insist that I wasn't allowed in the birthing pool as it is harder to quantify blood loss when diluted in water. They also made me have a cannula in my hand from the early stages of labour so they could get fluids on board fast, if needed. This one may also be due to me having thin wriggly veins that are hard to get needles into!