Post partum Hemorrhage (PPH)

[tootyboots]

Am new to mumsnet, so am keen to see if i get any reply to this! I gave bith to my wee boy Findlay in April - he was 9lb 9oz, i was in labour for 25 hours and ended up having to have an assisted birth with forceps. Immidiatley after the birth i hemorrhaged badly and ended up having to have a blood trasfusion the next day (on my 1st wedding anniversary!)Findlay was fine but it has taken me almost 3 months to recover as i had A LOT of problems with my stiches and also suffered a uterine prolapse and just found out last week that i also had a heamatoma (dont know how you spell it!)(basically a gathering of blood inside me , commonly caused by heavy blood loss. So to cut a long story short i am thinking of the furure and having more children however and scared that i might hemorrhage again, as i have been told that the chances are quite high. I was wondering if anyone has any similar experiences and did you decide to go for a c section instead and did this work? any advice or stories appriciated. x

Hello,

Why did you end up with forceps?

Did you have a full bladder?

I have had a forceps assisted VBAC and also had a Haematoma and am currently having physio for my pelvic floor, so I can appreciate your predicament.

Having a CS is no guarantee against PPH I'm afraid, but doing your research into normal birth vs elCS should help you to make the right informed decision for you.

Tell us more about your labour, what positons did you labour in, what, if any, pain relief did you use, etc. Then we would be better placed to answer.

(((((((((HUGS))))))))))) for what you've been going through

Thanks so much for replying to me! My labour was very long (25hrs). I started off well, in the birthing pool, dialating to 6cm within 4-5 hours, (about 11am) i then made the mistake of having an epidural which i am convinced slowed everything down. I think i had morphine but to be honest i was really spaced out on the gas and air and dont remember much. By 5pm i was still 6cm and the epidural had worn off, it was topped up several times - i dont know if this contributed to me feeling spaced out. At 12 midnight i was 9 1/2 cm but totally exhausted - i was totally numb and had no feeling of when to push. Findlay's heart rate was starting to slow with every contraction so they decided to take me into theatre in case i needed a emergency c/s. They tried to top the epidural up but it didnt work so they had to give me a spinal block (not nice) I had a large episiotimy and they used forceps to deliver. I hemorrhaged after this - i think it was due to my uterus not contracting as it should or something? I too am waiting to get phisio for my pelvic floor (AKA - the wizards sleeve!!!!) Am just really confued as to which would be the safer option for birth next time? x

oh and also - no i am pretty sure my bladder was empty as they were manually emptying it for me (nice!). I was half sitting for most of the labour after i came out the pool as i could not move after the epidural. Hope this helps! :0 x

I had a PPH (1500ml) after DS was born, with a forceps delivery. I had a blood transfusion later on that day and was a bit concerned about what would happen in a future birth.

When DD was born, I still bled a bit (about 300ml - I think 500ml is considered a PPH) but it was an easier labour.

I think the forceps delivery made a difference with DS (his heartrate was very low and he needed to be got out quickly) but also I think that I am maybe slightly pre-disposed to having a higher blood loss than some people.

Hi Tootyboots,

You're right to think that the epidural slowed things down. You'd done so well up till this point! But what's done is done and you mustn't beat yourself up about it, instead learn from it!

PPH is statistically more likely to occur after intervention such as caesarean section, assisted delivery (forceps or ventouse), or medical induction or augmentation of labour (having a drip to speed labour up). And the worst case scenario after a CS is emergency hysterectomy due to uncontrollable PPH. So an elCS next time is not necessarily the answer.

It is likely that the forceps was a major factor in your case and if so then carefull planning of a natural birth next time will minimise your risks of PPH.

You might also like to visit Birth Trauma Association.

Look after yourself

I had this after ds2 who was 10lb12.5 and the doc thought there would be no time for a transfusion and wanted to take me to theatre there and then for a hysterectomy!!
thank god they sorted me in the end but we want more kids but dh is scared in case it happens again.
will watch with interest and just wanted to say i'm glad you are okay and I understand your fear.

have read some of the other posts and now am more scared as i had waterbirths both times.

Ladyoftheflowers, don't be scared, get educated! Do your research into PPH, get to know yourself and make informed decisions.

A waterbirth should have no effect on pph, ie cause it, and here is a link from the Home Birth reference site where you could start reading.

HTHs

tootyboots,

I had similar experience with last baby. Early in my pregnancy ultra sound showed that my placenta was low. But when I went back the doc said everything was fine now. So three weeks before my due date my water broke. I called doc and they said to go in. So I went in but I had no contractions just broken water. So they decided to do a potosin drip(probably spelled wrong) to get things moving. So after 11 hrs I noticed fetal monitor was showing babies heart rate dropping. I called for a nurse who called for doc. All of a sudden they wanted me to pust the baby right then. Baby came out 15 minutes later with knuck cord and facing up. I was so worried about her that i didn't notice they were still working on me.

All of a sudden I realized I felt really really woozy. I looked at doc and said,"I don't feel so good." Fell back onto bed and started hurling. Pretty soon I have a nurse plowing my stomach with all her weight while doc is giving me a shot and another nurse is hooking up a second IV. Thats when I finally realized that something wasn't right. Duuuhhh. Any way I guess my uterus wasn't contracting for some reason and bled really really bad.

It was a very traumatic experience. I was fortunate because I had two good experiences first so I wasn't to turned off.

Hiya, I suffered a PPH myself following the birth of DS 22 months ago. I lost 3 litres of blood following a 30 hour labour and delivery by forceps.

After this I thought I would never be able to go through this again but here I am 30 weeks pregnant.

I have spoken to my consultant who strongly advised against a c section. She informed me that it is unlikely that I will suffer a PPH (although a higher than normal chance) again especially if I don't need forceps again.

After my experience I found it helped by going through all my maternity notes, speaking to my consultant and gathering information regarding what happened from the internet. I also spoke to the Birth Trauma Association. I recommend that you do this as they are very helpful and sympathetic.

HTH

J

Hi I had a PPH with DS1, (after a very easy pregnancy), was scared of it happenning again, but as they knew about it I was hooked up to a drip, to stop iy happenning again and this timw was in a significantly better state afterwards. Am now 23 weeks pg with baby no 3, I found that it helped me to write previous PPH at the top of my birth plan as I felt that anyone looking at it couldn't miss it!!
It is scary doing it again, but I found that I needed my positive birth experience to get over what had happenned first time around

Hiya, loopymumsy!
thanks so much for your info - it really helped. i will def. be looking of the web site for more info/support. You are right that a 'bad' bitrth can leave you with a lot of negative emotions. I felt a MASSIVE failure for the first couple of months and if i am honest still do but just accept it now rather than worry about it all day. I felt that i had not only failed my beutiful boy but myself by not managing by myself. Everyone around me has been really supportive and told me its not the case but i think unless you have been through it - it is hard to understand. Only others who have had similar deliveries (i.e forceps) seem to understand and feel the same or similar. It does appear from peoples posts that an el/cs is not the answer to a 'safe' delivery (quite the opposite!) like my husband and i had originally thought. I would dearly love the chance to do it 'properly' but just didn't want to risk anyone's life in the process! I could not bear the thought that my dream of a 'normal' birth would leave either my boy without a mummy or me with a injured (or worse) new baby (and of course my husband a widower) however as i said it does seem that my best (and safest) chances are to try for a natural delivery.
P.s has anyone ever heard if endometriosis increases the chances of problems during birth/labour - as i have/had this also.

Hi Tootyboots, lots of sensible advice here. My first delivery had lots of features in common with yours, but I have had two good deliveries since with no sign of a haemorrage. Having a de-brief session with a midwife and your notes is helpful, and also I did an NCT ante-natal course for mums for whom it wasn't their first delivery, when my 2nd was expected. Before I had my first child my doctor (a mother of 4 herself), said "don't expect your first delivery to be picnic" - so don't let your first experience be a guide to what you may be capable of - in my 2nd delivery I only used a TENS machine and felt so positive and in control that I felt I could have done it all over again within an hour!
I do wonder myself whether having an epidural and syntocinon(?) drip to speed up the labour actually sent DD1 into distress, but hindsight is a wonderful thing - and DD1 is a healthy bright child now anyhow. She was a venthouse delivery, so savagely yanked from the womb that the chain holding the cup on her head actually broke! Hardly surprising that I haemorraghed. I didn't actually have a transfusion, but my blood count qualified for one, and the epesiotomy that I had made sex painful for a full year, (although I conceived DD2 before the year was up!) If you look at other threads I think you will see that most 2nd deliveries are a helluva lot easier than the 1st time, so take courage!

Tootyboots - It sounds as though you are dealing with this really well. I hope your physio helps your pelvic floor.

Thanks lillochum!
Your note,too is really encouraging. Its interesting (and down-heartening!) what you you say about having sex. When i was atthe hospital a couple of weeks ago regarding a 1st stage uterine prolapse (what next?!) and also the hematoma the consultant said that i was still quite swollen down there . I too had a doctor straight from hell who sadly was with me right from the beginning (and who had seen me a couple of weeks before with a false start and left me bleeding and unable to move for 1/2 hour after a simple internal exam - aparently she tried to PULL my cervix down sho she culd feel if i was dialted or not. Funny how the other doctors andmidwifes had managed without any problem!My husband tells me that she was acctually gritting her teeth trying to pull Findlay out, and it the end she had to call for another DR who had him out within 2 contractions. My son although very bruised and battered when first born recoverd very well (managing to escape a cone head!) however he had been left with a red mark across his right eye lid (looks like someone has just nipped it) i assume that the scary Dr caught the forceps aross his eye - i am just thankful that he is not blind and i can still walk - just! I also felt very let down by my local midwifery service who left me with a developing abcess (it was the weekend - i had just been discharged on the thurs) and then told me to be patient a wait for my stiches to dissolve (even though i told them that previous dissloving stiches had not dissloved)Well i asked and asked for help and in the end had to have the stiched CUT out as they has embeded themselves in my skin they were so tight OWWWWWWWW! More tears, more truma. I am still hopeful that next time will be earsier as you say (well it couldn't be much worse!)Just frightent that history might repeat itself and by that point it will be too late. When the time comes i will def. look into antenatal classes for 2nd time mums - that sound as if it would be a great help.

hi tootyboots,
it could have ben me writing your post 9 yrs ago! i had an induced labour with ds1. 26 hrs folllowed by episiotomy, forceps and immediate pph. ds1 was 9lb 12oz. i had 3 blood transfusions throughout the night and next day and felt really unwell for quite sometime after. plus a botched stitch up job meant i had to have the episiotomy recut and stitched 6 months later. ouch1
i was also quite traumatised by it and when i became pregnant the second time i was terrified of what would happen as reaally genuinely thought i might die the first time around. so i asked forn a cs and they let me. i did still haemmorhage but it wasnt so bad and i didnt have to have a transfusion and i had to keep the drain in for longer than most but i felt much better than after the first (i suppose as well because i hadnt had hours of labour either). ds2 was 8lb 13oz so quite a lot smaller.
dd was born in 2005, induced labour again but only 6 hours this time. no drugs, no haemmorhage and she was only 8lb 5oz.
they say its most common after a large baby, where the placenta is bigger and where it comes away from the womb thats where the bleeding comes from. i dont knoww but i know it was much easier the next time around and the third. there is poss of haemmorhage after cs but i guess because you havent had hours of labour to endure as well then you are more able to cope. also they can give you an injection to try and lessen the bleeding which is what they do with me. as its in a theatre with loads of doctors and midwives it is in a more controlled setting so they csn deal with something like that more quickly and efficiently and given your history they will be prepared.
hth

Tootyboots, I'd also suggest taking ds for cranial osteopathy to sort out the trauma he has suffered to his head and neck. How has he been since birth? Does he cry a lot, seem colicky?

And BTW, YOU did not fail, You were let down by the HCPs who were 'caring' for you [derisive snort emoticon]. You're not a failure!!!!!!!
((((((((((Tootyboots))))))))))

I lost 500ml after my elective CSec. Basically I threw up in the recovery room and it all gushed out! I thought it was pretty funny at the time but was still under the influence obviously. He was 9lb if that makes any difference, I didn't have any PPH with my 7lb firstborn.
Hugs to Tootyboots btw, what rotten luck.

Hi Klaw!
Thanks again! i am feeling very posotive about 'next; time - i am determined i will manage myself. I know it was not entirley my fault but the feelings are still hard to chase away. As for Fin i have been very lucky and he is very chilled - no colick and hardly every cries (at least i hope this is a good sign???) He is genraly very happy, full of smiles. he does nit seem to mind his head being toughed either which i am happy about. I have made a I have made a point of being toughy feely with him, baby massage etc and he seems to really like it. He is the only good thing that came out of the whole experience and i would do it all again for him! He was soooooooooo worth it! x

hiya, i suffered a pph with my son now 20 months old, well i started bleeding in labour, and then as i had him it just got worse and worse, the blood that i was loosing during labour wasnt recorded but the blood i lost when i had him was as they scoopt it into bowls, and that was 2000+ml. ant then 4 weeks later i heamorhaged again,went bak to hospital and found out i had an infected womb, due to afterbirth been left in me for 4 weeks. was terrified about having another even though i wanted one, but now just found out im pregnant, and absoloutly terrified i think im gonna die. how likely is it i will heamorhage again

Hi Tootyboots - I thought I would let you in on my experience .. I had a pph from a third degree tear.

My labour was relatively fast and I had a water birth and have no intervention until after the delivery and the PPH.

I was able to speak with a consultant, and after about 3 months I went through my hospital notes with a MW. I found both really beneficial.

The consultant said that there was debate about tears and waterbirth - as sometimes there may be less control with the delivery.

The consultant said pelvic floor exercises were really important - suggesting I do them every time I have a cup of tea.

He also said there need not be a repeat performance with tears for your second birth. I would suggest when you are up for it that you go through your medical notes with an experienced mw. It did me no end of good.

I am sorry to hear about your experience.