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.

That is interesting that most don't remember it being discussed. Certainly the risk is low but how would you have felt if you did have a large bleed and had to be transferred to hospital?

The definition of a PPH is blood loss over 500ml, however most women cope easily with that amount. It tends to be amounts greater than that , causing the women to feel symptomatic (faint, rapid pulse) which are the ones needing transfer.

Mears - may not be relevant to your research, but still interesting.

I had a homebirth in Belgium. Two midwives were present, and one student midwife, all trained in setting up an IV. They gave me IV antibiotics during the labour for GBS.

They had a colloid available (gelofusion or something similar) if I had haemorraged, and would have phoned for an ambulance.

I lost 500ml during the birth (although how they knew this I'm not certain - I had a water birth ) and lost large clots that night. I fainted twice in the following days, and had a hb of 8.5. I wasn't transferred to hospital, but had daily mw checks, and lots of iron tablets / iron rich foods.

PPH is the one thing that scares me the most about giving birth, as the blood loss (not sure if it was diagnosed PPH) effected me for 6 months, although I only realise this in retrospect.

yes, i had a long 27 hour (from first contractions, i know that doesn't exactly count!) labour so maybe that is why. I guess the tear was the cause as the synto. stopped the bleeding so prob not my uterus? again sorry for interrupting your thread mears!

The synto is administered to make the womb contract down to a small size after the birth. That's why the bleeding stopped I imagine, that's why they give you it.

The tear would not have caused that level of blood loss. The bleeding would have been from the detaching placenta, which is served by many blood vessels...if your uterus is tired, like after a long labour, it might just not do what it should - ie shrink down straight away - so these blood vessels remain unsealed, and continue to bleed heavily.

When the synto is given, it immediately causes big contractions of the uterus, causing it to shrink, this has the effect of cutting off the blood vessels and pushing the placenta out. So the bleeding stops.

HTH!!!

I was advised that PPH risk was the same for HB as for a hospital birth but that I would need to wait for an ambulance and go into hospital if this happened. Hospital about 30mins away. The MW also said that generally problems did not suddenly occur but that there would be indications of problems over a period of time allowing us to discuss the 'maybes' at the time. No mention made of them being able to put in a drip so I assume that they could not/would not in Birmingham.

Thanks flightattendant! Good to know all these things for next time round...

Just one point, relating to forgottenfreetime's post...in my case there was absolutely no time frame in which to discuss potential problems, any problems that presented were immediate, it was all so quick...this is what makes me less inclined to have a homebirth next time as if I'd had to be transferred, it would really have been an emergency situation and I'm not sure it would have been Ok...so worth bearing in mind that your labour might be very, very quick, because it really has an impact on the options for management of any issues.

Just had this chat today with m/w. Was due for home birth but iron levels now below 9 and they're not keen, esp. as we live 25 mins from hospital and up to over an hr. away in the daytime traffic - currently can't get there easily due to flooding. My m/w said they can't put up drips. We'd have to wait for paramedics to administer treatment if i haemmorhage and then take me to hospital.

Cupcakes, have you been taking iron? How far are you in your pregnancy, it might be worth starting Spatone or similar, I found it got me up to 9.8 pretty quick and they stopped making a fuss about the homebirth then

Interesting thread. I have not had a homebirth (sadly - would love one) but even in hospital my experience was that midwives were not allowed to put cannulas in or even to flush them out. I had placenta praevia and a number of heavy bleeds with dd1, and had a cannula in for some time. It had to be put in by a doctor, and it kept blocking because they were supposed to call a doctor to come and flush it through every four hours, but they could never get hold of one to come and do it... which is understandable, I guess -my cannula wasn't terribly important in the scheme of things - but had a midwife been allowed to flush it out it probably wouldn't have blocked all the time, and had I ever needed to use it (I didn't thankfully) it would have stood a better chance of being usable!

I had a VBAC with dd2 and was supposed to have a cannula in then too. But by the time they got a doctor to come and put one in, I was pushing so they didn't bother. Again, it had to be a doctor who did it.

Re. 'fist up the fanjo' - my consultant told me that 'in the olden days' women with placenta praevia were made to labour like that. The baby wouldn't survive but sometimes the mother's life would be saved. (This was when I was trying to discharge myself so they all queued up with their pp horror stories to make me stay in!)

Mears I don't remember it being discussed either - but then I am medically qualified so a lot of assumptions may have been made about my understanding of the risks!
But I think your point about informed consent is very valid - probably it would be advisable for a structured consent/counselling form to be used for home birth, going through what might happen if certain complications occur at home.

Flightattendant - I've been taking iron supps. but still way below 10. Disappointing. I just got to the pt. when I felt I needed to make a decision one way or another -found coping with a sort of two-pronged attack difficult. Also, I wanted to be able to tell DS what might happen. The 2 girls are younger, but he is 6 and has mild Aspergers and needs to have some clarity. All in all I feel easier for making a decision. My last birth at hosp. was great - waterpool, m/ws left me to it - even let me hold baby's head and deliver her and they offer aromatherapy too. Will leave after a few hrs. all being well.

Thanks again. IV cannulation used to be the domain of the doctors but it is moving to mursing staff and midwives, and nursing care assistants.

I can cannulate, flush the cannula and give IV drugs.

Ellbell - it is onlt recently that midwives and nurses have been allowed to flush cannuale for the very reasons you describe. No point having a cannula in that can't be used.

I am no closer in finding the answer whether community midwives should be able to cannulate.

I again say how surprised I am that PPH hasn't been mentioned to women planning homebirth .

Cupcakes, it sounds like the sort of hospital birth we'd all like!!

Best of luck xx

That makes sense, mears. (I didn't want the sodding cannula with my VBAC anyway, so was pleased to avoid it, but it would have made sense for a midwife to have done it.) My experiences were 7 and 5 years ago, so possibly out of date in my old hospital too, now.

Interestingly, when dd2 fell and cut her face badly and had to be stitched under general anaesthetic, the doctor couldn't get the cannula into her little veins (she was 3 at the time) and an older, obviously very experienced nurse had to do it instead. Dd didn't even realise she'd done it!

Mears - mentioned this to my sister who is training to be a GP and currently in obs and gynae. She didn't know that there were midwives who couldn't cannulate... but then there are probably a few differences between hospital and community midwives? After my last homebirth, my sister was horrified I had even considered a physiological rather than a managed 3rd stage. She said if she had known she would have had a serious discussion with me to put me off, but then accepts because she is a doctor she tends to see the worst cases rather than the vast majority.

Got my home visit and homebirth pack being delivered tomorrow and the chat so will let you know what happens.

Mw didn't mentionn all worse case scenarios, but was very reassuring, alsO I knew she could cannulate if needed, as it was turned up with nothing, as short notice, just home delivery pack in cupboard after I said I really think something is happening

In order to cannulate you need to do the training and then get the practice. The CMW in my area do not routinely work in the hospital so would have difficulty getting the practice. I do think though, this could be overcome. The problem is that the CMWs do not see it as a need. The thought is that if there is a PPH, an ambulance will be called and the paramedic will cannulate.

It is also thought that the rsik is so low, it is pointless midwives training to be able to do something that will hardly ever be needed.

JFL - no disrespect but your sister will have no experience of physiological third stage and will opt for the medical model of active management as the gold standard. Hope your homebirth goes well and all is physiological so that you can tell her all about it

Honestly can't remember a word about pph being discussed with MW before the HB when I lost about 750ml. Considering how bad I felt postpartum, am happy about being taken in to hospital, although hated how long it took to get out again.

Hi Mears - I know I know She can't help worry about me.

Well we didn't discuss pph at all until I brought it up as mw was leaving. She said basically the same as you. She wanted to be able to cannulate, but was told that if they ever needed to, and failed to do so, then they wouldn't have a leg to stand on, so yes we have have to wait for ambulance round here. Basically though, they monitor you so carefully the SLIGHTEST hiccup or upset then they send you in anyway. I didn't find the monitoring intrusive in any way last time though. Felt they pretty muh left me to it.