Fast first labour with PPH - seeing consultant soon re 2nd birth will they advise induction?

[KatharineClover]

Hi everyone,
I wondered if anyone has been in a similar position? My first labour (at 39+5) was pretty fast at 3.5 hrs from waters breaking to baby (I had mild contractions every 3 rising to 2 mins from 12am, checked at 5am and found to be 1cm, my waters broke at 9:15am with heavy meconium (that's when they 'started the clock') at 11am I was 5cm, by 12pm I was pushing and DS was here within 45 mins). I then had a PPH of 1 L and went unconscious, I needed 2 pints of blood.
I am now 18+5 with no.2 and I live rurally about 25 mins from the hospital. I am worried about having an unplanned unattended home birth or birth en route in the car due to the baby arriving faster than I can get to hospital. I have family 5 mins away so childcare can be here quite quickly.

Has anyone else had previous PPH and fast labour? Were you advised to have an induction so you could be sure you would labour in hospital? Just wondering about what to expect of my consultant appointment, I will be taking DH along for some hand-holding (also he was quite traumatised by DS's birth so hopefully this appointment will ease his mind too).
Many thanks x

Hi; I had a pretty fast first labour at 38 wks (5 hrs from start of contractions to delivery), then had enough blood loss afterwards to make me go v v white & faint, and require a saline drip, although no transfusion needed so nowhere near as serious as your experience.

FWIW, When it came to discussing 2nd DD birth, there was no mention made of needing to have an induction; I did discuss my previous fast labour, and was just told to make sure I had the phone numbers of the on-call midwives to hand. (I am ~15 mins drive from the hospital BTW.) Personally, although I was lucky enough to receive a really good level of care in hospital during both my DD's births, I still wanted to labour at home as much as possible.

They were also happy to let me have a physiological 3rd stage, even though I had the blood loss previously (which may have been rash on my part, but I felt strongly about it.)
However, if you favour an induction, I would say it's definately worth discussing with the consultant of course, as the amount of blood loss you had might be a more important consideration for you.
DD2 was a 3hr45min labour from start of contractions to delivery, by the way.

My 2nd labour was 2 hours ( first one 7) from first contraction, and I had a 2 litre PPH, emergency surgery and a transfusion. I got to hospital 10 mins before delivery and we were not hanging around at home waiting!
I'm consultant care this time and the best they can do is "set off straight away" though they will manage third stage more aggressively, put a line in on arrival and have blood cross matched and ready if we get there I intend to ask again about induction at 34 week appointment as I'm v worried about delivering away from hospital. NICE guidelines are not to offer induction for this reason though....
Your labour doesn't sound fast though? 12 hours from start of contractions is pretty average for first labour?
Please let us know how you get on!

I think you might struggle to get an induction as a 1l pph only just classes as a major one. 999mls or less is regarded as a minor one. Tbh I think its likely to have been underestimated (they are really just going by the puddle on the floor) as I've not heard of others needing transfusions etc at that level. Wonder if u could dispute your old notes? One pph does raise yr risk of more so I can totally understand yr worries. I had one w each delivery... But they were much more on the ball second time round and went into action and I lost half the previous amount.

My PPH was 1750ml and I was borderline for a blood transfusion, though I couldn't get home quick enough and discharged myself. This was extremely foolish - I spent the next couple of weeks barely able to function. Anyway, fast forward a bit and I'm now 26 weeks along with baby number two. Consultant says they'll be ready for it this time and will actively manage the placenta bit ie get it out pronto rather than wait for me to deliver it naturally. I was expecting a bit more really, but the impression I got was that it's very common and no big deal.

I think a lot depends on the reason for your last PPH. Mine was put down to episiotomy and slight tear, but I am not convinced either contributed much. Bit worried about it happening again but I'll certainly take all the advice and care I can get this time as long as there's no hideous midwife barking at me to breastfeed again.

Good luck!

Thank you so much for your replies everyone :)
bakingtins they said they classed my labour as 3.5 hours, as before that I wasn't dilated (although contracting a lot!) - I thought that was fast? But should I really count from when I felt the first pain?
It is interesting to know that other people have had bigger PPHs and not needed a transfusion (my friend also had one of 1500L but no transfusion) - my iron level (hb?) afterwards was 7 and I couldn't stand without dizziness / fainting - I had 2 pints of blood to get me up to 9. But even then, I felt awful for weeks like you iamamonkeymess, and I had iron tablets too.
I'm not particularly keen to have an induction, I just want a plan to help avoid things going wrong at the roadside etc! I also have SPD and the maternity unit is on the second floor - it could take me quite a while to walk up there!

Make sure you are having your haemoglobin levels checked in pregnancy, sounds like you were probably already anaemic last time if your levels dropped so much with a 1 litre loss. I'm keeping my levels pretty good with Spatone in an effort to avoid the tablets.
I guess they are saying that's a short active labour, but I think this time you just get yourself there whenever pains start and refuse to go home if they say you're not yet in active labour. I was