C section or not for 2nd birth? Haemorraged on previous labour...

[Keepontrudging]

Hi everyone,
I am really undecided how to go about things this time around. The birth of my daughter was traumatic for numerous reasons - though thankfully my dd was fine when (finally!) born. I am due to give birth again (just 20 months on from having dd) in Jan. Due to complications with this pregnancy (possibility baby could be small/ small amount of fluid around heart) and the fact I haemorraged after giving birth the last time and was so drained and weak (despite iron transfusion) I thought an elective c section would be best and it was agreed I could have of I liked by the consultant (thohgh they haven't said I need one)
I have done a bit more research and found that having a previous post partum haemorrage increases your risk by x3. However I just read having an ELCS increases your risk again x2! So now im thinking maybe an ELCS isn't best and maybe having a vaginal birth would be. But the thought of having hours of labour again and then having another instrumental delivery and haemorrhaging after it all terrifies me! I just don't know. What tempts me about an ELCS is the fact it will be controlled and I will be able to rest prior to it and then come home hopefully not too exhausted as I was in labour days with my dd on and off. Sorry for them ramble. I at a loss as what to do!

It's a difficult decision that only you can make. If it helps I also had a pph with my first dc. Like you I had an instrumental delivery and a very long labour with loads of intervention. This resulted in me losing 6 pints of blood immediately after delivery. Anyway ffwd 25 months and the delivery of my second dc couldn't have been more different. All HCP's were well aware of previous history and were very on the ball. I had a consultant led delivery. We were aware that there was a good chance I'd have another pph but with a much more straightforward labour and delivery that didn't happen. I had a wonderful birth experience which I hope to replicate with dc3 due in Feb. I personally am glad I didn't go down the section route. I hope whatever you decide works out for the best. Good luck!

I guess it's up to you to decide what option is less risky.

I had an instrumental birth with my first and lost just over a litre, decided to have a vaginal birth with second (also 20ish months later), he was premature at 35 weeks, no instruments or painkillers but placenta got stuck and I had to go under GA to have it removed and I lost over 2 litres and had a transfusion. Recovery was easier this time though as I didn't have huge wounds to heal along with the feeling weak.

I myself have no idea what I would choose if I had a third, I'd probably go for vaginal as at least there will be a less likely chance of being cut etc. I hope it works out well for you.

Do you know the reason for the PPH in your first delivery as there are a few things that can cause them. Mine was due to DC1 tearing my cervix and I lost over a litre of blood.

I had DC2 21 months later then 2 more vaginal deliveries. All up 4 deliveries in 6 years.

I never had another PPH although each time I was closely monitored not allowed in water and had to have a cannula in my hand from early on in case they needed to get fluids in quickly. But I have thin wiggly veins!

Can you ask to have an appointment to discuss before you make your final decision?

Does your hospital have a VBAC/debrief clinic or similar?

I know you aren't after a VBAC, but I found it extremely helpful to go over my notes from DC1 with a specialist m/w, and get a clear view of what went wrong, why it went wrong, how likely it was to go wrong again for DC2.

We also discussed the risks vs. the benefits of vaginal and section births in every scenario. I got a lot of research to take away and read, to make my mind up in my own time.

It really helped and I came out with a much clearer head.

I had a PPH with DS but only about 1.5 litres so not especially big. I had a forceps delivery and it was a bleed from an internal tear. I never considered having a Csection with DD as there is 22 months between them and I didn't want to deliberately have surgery.

Second birth much better and only had a small graze I lost about 500 ml of blood which was fine.

Sounds to me as though you need to discuss further with the consultant - I had 3 appts discussing the pph I had after dc1, I can see why the thought of a c-section is attractive but when I discovered i could end up +pph in either case, I decided to try and avoid the extra surgery if possible. Being induced in a few days - good luck op, do what makes you feel comfortable but I'd get more specialist input before deciding and make sure you have as much helpful pp support as possible. At least this time the recovery won't be a surprise.

I don't know about the statistics. But I had x2 PPH and I felt far worse with the first emergency CS compared to the 2nd elective (even though it was rushed forward when Dc2 decided to arrive early). I'm sure it's not always so straightforward but with DC1 I struggled with stairs etc for the 1st week and was knocked out with exhaustion. 2nd DC and I practically danced out the hospital in comparison.

I had a pph and transfusion with an instrumental delivery - lots of tearing, so I assume it was that. My consultant has suggested that I am not particularly at risk of a pph with a CS - it will be a calm, elective CS if everything goes to plan.

I'd try to have another discussion with your consultant to see what they think about the risks either way.

Long labpurs and instrumentals are also risk factors for a pph.

You're less likely to have a long labour or an instrumental with your second labour.

viva you are right... I was told basically the long labour was probably the cause - my uterus would have packed in and wham! the blood loss began. I don't know much I lost , but I know it was enough to need a transfusion.
I am still undecided, I will speak again to the consultant at the growth scan on the 21st of this month. If baby is a good size and the small amount of fluid has gone from around his heart, I may feel more confident about going through with a normal labour...I couldn't bare the thought of not being able to be so hands on with my dd1 and being away from her long than necessary - I fear though, that if I do have a normal labour it could go wrong and I could be in hospital a long time. I know this is unlikely, but atleast with a c section you generally know where you stand. Thanks for the input ladies.

I had a massive pph when DS was born (7 litres), again caused by long labour, forceps and LOADS of tearing. 3 years later pg again and was going to have a lovely calm water birth, the midwife was happy and confident that there was a good chance all would be well, but if I did bleed again they would be prepared. In the end I had placenta previa so had no choice but to hsve ELCS. It's not what I would have chosen ideally but actually was fine and I recovered quicker than from my first, very traumatic birth. The placenta previa also increased my risk of pph but I only lost 700ml so was fine. I would say try for a VB if you can and that is what you want, the hospital staff will be aware of your history and look out for early signs and risk factors developing so can act fast if you do bleed. Good luck!

I had a 1 litre PPH with my first birth (due to fast labour, big baby / uterus not contracting down quickly, and tear / episiotomy) and 2 pints in transfusion, it was very traumatic as DS1 needed resus etc.
My second birth was 4 weeks ago and was wonderful, exactly what I had hoped for (even though I wasn't allowed in the MLU and had to be in delivery suite) - no pain relief, doula, natal hypnotherapy. DS2 arrived in under 6 hours from first contraction in a lovely calm birth - he was 9lb 15oz! I had a graze/small tear. My blood loss was only 300ml and I was up and about an hour or so after birth. I was lucky circumstances went my way, but very grateful to have a fab midwife and a lovely healing birth.

I opted for elcs after similar experience with #1. Best decision I ever made!

Good luck ??