Those who had a homebirth - what were you advised would happen if you haemorrhaged?

[mears]

Did the midwife say what would happen? Could she put a drip in if needed? Would you just have to wait for an ambulance?

Doing a bit of research here.

mears - what's the downside of enabling mws to put in a drip? doesn;t seem like there is one to me. surely it would be an excellent idea to improve (even more) home birth?

Hi Mears,

I had a heavy bleed immediately after DS2 was born, ten days ago. I don't know why, it wasn't the tear (which was 2nd degree) so must have been to do with the placenta etc. I imagine. (I asked but nobody knew, they said it was probably because I was anaemic? Though level was at least 9.8)

I had been warned as you may remember that I'd be more likely to bleed and they didn't really want to recommend a homebirth for that reason and also because I didn't want synto...thought it had made me sick last time, in fact my theory was disproved as I had to have it this time and it didn't.

They said I ought to be in hospital for the birth unless I could get up to 10 on the Hb front. No advice as to what would happen should I haemmorhage, our nearest hospital for this scenario is a 45min drive away since the local one was downgraded to a midwife led unit. (Very nice I'm sure, but not helpful if you want a home birth and are worried something might go wrong!!)

Anyway I was pouring blood, sitting there staring at it like a tap was on and assuming I was going to die. (Sorry TMI!) They gave me the synto straight away with my consent, and it seemed to stop...used controlled traction etc.

I didn't have to transfer but had I not had the synto they said it would have been an ambulance and (I inferred from their expressions) pretty dire / touch and go.

I was fine but did lose about 600ml within about one minute. Lucky, very lucky...they were calm and (to me) confident throughout, though my doula said they were starting to panic when the bleeding happened.

HTH xx

Mears, depends when the pph actually occurs I guess, If mw are still there they are trained to deal with it and if worst case scenario happened I think they would be sat with fist up fanjo compressing the uterus. Or are you not allowed to do that as a mw?

A friend had a HWBAC 18 months ago and then pph. Will have to go ask her what they did at home if you like. And could email you story with area it occurred in? She definitely had fist up fanjo but that might have been in the hospital...

She has researched a lot into pph since and is convinced it was due to not emptying bladder. I always stress this now to reduce risk, and was always asking my client if she'd been to the toilet as she was concerned about a long 3rd stage as previous... turns out placenta fell out within 10 minutes!

To answer your original question, Mears, I asked about management of third stage when we went through my homebirth plan and we discussed PPH in that context (postpartum haemorrage, that is, not Princess PeaHead), largely because I was interested in trying an unmedicated third stage.

IIRC, the midwife said her approach to managing it would have been to call an ambulance and have me transferred, rather than fiddle around at home trying to fix me up. I assumed that was partly because we are only 10 minutes from hospital and I had made it plain that I was quite willing to be transferred if there were good medical grounds for doing so.

In the end I had a natural third stage and lost very little blood, so it was one of those theoretical conversations. I was glad we did discuss it, though.

I agree Mears midwives should ideally be able to put in an IV in case of a PPH. For me that was one of the concerns I did have when having a homebirth and I only had access to Synt given IM not via IV. In the end I decided it was a risk I could live with. I also had Shepherds Purse - it's a herb, supposed to work wonders.

Klaw, I emptied my bladder during transition about half an hour before boy was born...just read through the notes, it says that I was given synto after 4 minutes, not 1...time goes funny in labour!...and the uterus hadn't contracted well, I guess that explains why the primary haemorrhage.

I can't figure out why it didn't contract, none of the usual risk factors were present AFAIK...second pregnancy, very short labour (3.5hrs), nothing else I can think of?

Anyone got any ideas?

it wasn't mentioned that I remember apart from the 'there are risks but in that case we'll call an ambulance' kind of way
I had a catheter after an hour of waiting for placenta (physiological 3rd stage) and that helped as placenta popped out straight away. I was also told that I might get a large bleed later as had retained membranes but didn't transfer to hosp or anything
hth

Oh I did have ragged membranes...?

OH FA, empty bladder won't necessarily prevent it, I'm sure, but it I know it's one thing that we can do to try to prevent it. And I'm sure most of us would be far happier knowing that we've done all the right things and that there was nothing else we could have done. It helps with the control thing that gets to most of us!

My friend who had the PPH is also intrigued by the idea that those with certain colouring are more prone to pph. Anyone else got theories along this line, Mears?

god I'm probably the worst control freak ever!!!

Klaw- there seems to be quite a lot of anecdotal evidence of this, and as I work in a hospital and the policy is to use some kind of oxytocic, (unless requested otherwise by my patients ), I usually use syntocinon for most people, but for women with red hair, I use syntometrine, even though I hate the stuff as it makes so many people sick.
I have found that red haired people are more likely to bleed after birth, as are women with very quick labours, very slow labours, lots of babies etc.
Have not really seen any research to back it up, but I do help deliver a LOT of babies!

FA, you might have fallen into the 'quick labour' group, and your m/w would have been a bit more cautious about blood loss if your hb was a bit low.

As for cannulation, I would be a little nervous doing homebirths without being able to site a drip in an emergency!

Sorry for rambling on a bit, working night shift all week!

Mintpurple

I deliberately did not say which colouring a) so that I wouldn't lead the answers and b) because I don't want to put the bejeezus up some ladies!

But it is a certain type of colouring, including the skin which would appear to be more susceptible. Maybe you should keep a tally and do a bit of personal research. Not sure if you'd ever get funding to do a proper paper on it.

Do you find that you are more vigilant if someone fits your idea of who would be at risk?

Nothing was said and I didn't ask

Had a fabby homebirth, highly recommend it

Klaw - sorry....stumbled into that one!!

I suppose because the unit I work on is so busy and I have been doing this for a very long time, you get a feeling for who to keep a closer eye on after delivery, and with experience, a lot of potential problems are nipped in the bud IYKWIM.

I like to think Im vigilant with everyone, but I'm certainly checking on certain types a lot more than others

As for the research - it would be an interesting study. But I have found such huge variations on how different ethnic groups labour and birth that there are a wealth of studies out there waiting for the keen researcher!

Sorry for the thread hijack ladies.

Thanks again for your posts.

There are things that midwives can do and a 'fist up the fanjo' is one of them Syntometrine would also have been given. Agree about empty bladder. What I am interested in is whether midwives should be able to cannulate or whether mums should be advised that midwife is limited in what she can do at home. The reason I think midwives should be able to cannulate is because it is easier to find a vein before too much blood is lost and fluid replacement can help maintain blood pressure. I have to stress it would be a rare event, however I know some midwives can do it. Many wait for an ambulance to come and the paramedic (if there is one) will do it.

I am surprised at the lack of discussion really - where is the informed choice.

BTW - I know the theory about certain colouring however I don't think it has ever been proved.

My mw talked me through why she would use syntometrine - in the end i did bleed quite a bit and she said she would like to give me it and i agreed and everything was OK. I lost 600ml but have since read that a heamorrage is classed as less than that - what is the figure? At the time i was only partially aware of what was going on (!) although did notice worried looks from doula and mws to each other but in retrospect maybe it was quite serious? I had a second degree tear - would that account for it? Sorry, more questions than answers!

I was told that...
an emregency car medic would be called as usually very close, s/he would prep any emergency action canula, assessment and direct either ambulance or air ambulance (lucky to be so near to these I know)
A it was I was a blue light transfer due to long stop start labour adn after deciding ambulance was here in 4 mins and was in hospital 22 mins later - ds arrived easily curiously enough 25 mins after that.

But I am lucky as we are near several very serious accident heavy semi rural roads so good emergency services provide a good safety margin.
But midwife did tell me everything and ehr limitations.

Cheritongirl - sounds a bit like my experience (see below). I was told that 600ml was 'borderline' classified as a PPH ( Primary Postpartum Haemorrhage) but I'm not sure where you read the figure was lower, she may have been wrong...
I don't think it's the tear that bleeds so much, I had a 2nd degree also but the heavy bleeding was from the uterus, which failed to contract quickly thus the blood vessels serving the placenta were not closed off by it all shrinking up.
That is usually the reason for a PPH I believe...someone below mentioned a few predisposing factors, such as a very short or very long labour, for example. Does your birth fit into any of those categories?
HTH and sorry for hijack, Mears

It was never mentioned when I had my Homebirth. The only thing that was ever talked about was shoulder dystocia (which I'm not sure I can spell!)

I had 2 homebirths and it wasn't mentioned as a possibility either time. Altohugh second time mw said I would have to go in if she couldn't stop the bleeding. She could, luckily.

I was advised the risk was higher- as it was my 4th - of bleeding. Midwives brilliant and fully supportive of home birth as long as i agreed at the first hint of trouble i would be whisked off to hosp. I think i also had to sign something acknowledging the risk and warnings. Had no probs, not much bleeding and perfect home water birth

Cheritongirl - most places use 500ml as the cut off for PPH (but remember if you give a blood donation its more or less the same amount) so 600mls is pretty much borderline.

Perineal & vaginal tears can cause a pph but they usually trickle and accumulate gradually, while a pph from the uterus is often much more of a 'gush' (although it can be a slow trickle too), and can happen in seconds, so much more scary for the midwife.

Not sure I was advised (but can't remember) last homebirth 17 months ago, but will ask next week if not mentioned. She did ask if I wanted her to go through the homebirth stuff again.....I said yes please! Do remember about shoulder dystocia and being blue lighted.