Minor PPH in last pregnancy, am I at risk again?

[silversixpence]

I had a lovely water birth with DD then a natural third stage which resulted in a PPH. In the notes they have written 600mls blood loss but a doctor at the time thought it was less. The bleeding stopped eventually and I had a drip. I was transferred from the midwifery led unit to the main labour ward but was discharged the next day as planned.

At the time they told me I couldn't have a baby at the midwifery led unit again due to the bleeding but I would really like to and it is not clear that this was a 'proper' PPH from the notes - they have written no postpartum complications on the discharge form. I had my booking appointment yesterday and didn't mention it so have been put down as low risk. I thought if I had the injection this time that I'd be at less risk of bleeding but don't want to cause trouble/take unnecessary risks if it seems likely I'd have bleeding again!

You need to talk it through, but the concern might be that it was spontaneous. I had a PPH with DC1, after a very medical birth (very slow first stage, augmentation, forceps etc). And PPH despite having had the injection.

FOr DC2 and 3 I had homebirths, and naturally managed 3rd stage. I had talked through with consultant beforehand who said they had no problem with planned homebirth for me. That the PPH was likely a result of all the intervention first time, and no reason it should happen again. And if I did bleed, could always have the injection (you can wait and see).

Your bleed wasn't big, you didnt have a transfusion, and saying you can't be in a MLU (especially if it's close to a hospital) sounds quite conservative to me. They will have drips and things there. The only thing I can think of is that they couldn't say why you had bled the first time, so maybe that is a risk factor.

I would just talk through the options with your midwife.

I should mention that DD is my 2nd, I had a normal delivery with DS with no problems at all.

The midwifery led unit is in the hospital next to the labour ward but they don't allow any drips or cannulas there.

I would definitely mention it to midwife. I had a PPH with DC1 (1.7 litres) due to low lying placenta. Was told it was unlikely to happen again and didn't think much of it. It wasn't flagged in my notes and with DC2 I lost 3.5 litres. Although this has been put down to the fact I had traumatic crash c-section had my previous PPH been flagged they may have been more prepared and had blood on stand by - there was a 20 min delay getting the blood to me due to porter issues which may have contributed to blood loss.

I think my obstetrician told me if you'd had a PPH them you did have an increased risk of a further PPH.

Based on my PPH with baby #1, he's inducing me at 38/39wks with #2 to 'manage' me.

I'd ask the question if it were me.

Silversixpence- just one more thought although 600ml is still relatively low a 'proper' PPH is anything above 500ml...

You are classed as having a higher risk then someone who hasnt had one. So I would go through it. Although 600ml is on the lower side. Upto 500ml is classed as a normal loss during birth, anything above is a PPH.

I had a PPH with ds1 I lost 600mls in labour on itself and then a further 1.8 litres when I gave birth, this caused an high dependancy stay. Ive had 2 more children since, ds2&3 now I had to have managed births...no PPH,s with them though, 300mls with ds2 and 100mls ds3.

Im now pregnant with no4 and I have, been told il still need a cannular in my arm in labour just incase but iI can have a more relaxed birth this time hopefully a water one.

So while it may not happen again I would still bring it up just incase

This is something that worries me. I lost 3 litres after a forceps birth with DS in June, to be honest it has put me off having any more children!

I think it's something you should bring up at your next midwife appointment, so whoever delivers your baby is prepared.

I think I will definitely mention it at my next appointment, I am hoping they will say I can go ahead with midwifery led unit with an actively managed third stage but will try not to be too disappointed if they won't let me!