I had dreadful and immediate afterpains after birth of ds1 which accompanied a large pph. No afterpains that I can remember after ds2 and no pph. Now that I am pg with ds3, my iron levels are being monitored and an active management of 3rd stage labour recommended due to increased risk of a pph this time round. Do you have a sense of what the likelihood is of another pph and the consequences? I had to have 2 units transfused first time round as my iron was dropping by over a gram a day (hence trying to get me up to reasonable starting point so the end point of loss of iron doesn't require transfusing). Do have visions of uncontrolled blood loss and emergency hysterectomies...but I do tend to plan for the worst case scenario . Some sense of the actuality would be helpful if anyone knows.