questions about pph, big babies and homebirths

[fingerwoman]

had my home visit from the midwife this morning to discuss my home delivery plans.
She put on her concerned face and did that annoying sucking in air thing when I said that DS had weighed 9lb 1 and that I had been taken to theatre for stitching after he was born.

She said that previous PPH is a contra-indication for homebirth and that they don't carry drugs to help stop bleeding should I bleed heavily after birth.
I can't remember much from DS's birth tbh, but vaguely remember them saying I'd lost 500ml- that isn't THAT much is it? does that count as PPH? they said I'd had a haematoma which is where all the blood had come from and that's a different thing entirely isn't it?

She also said that I am more at risk from PPH because ds was big and so this one is likely to be as well.

SO, how worried should I be? is pph in my situation a real concern? how much more likely am I to suffer from it just because I have a big baby?

I wasn't aware there was a link between pph and big babies. All mine were 9lb and over with ds2 being 9lb9 and 2 were homebirths. The midwives never mentioned pph to me at all.
Sounds like the main concern is your previous birth - did you have to have a transfusion?

DS was 9 lb 10 but I was still allowed a home birth with DD who turned out to be a mere 8 lb 12. Had episiotomy and stitching with DS, but nothing with DD.

nope, no transfusions=

Message withdrawn

500 mls is the point at which blood loss is classified as PPH, so you are just on the cusp really ...

speak to head of midwifery or consultant midwife, have a look at the AIMS site and the homebirth site, and make an informed decison.

thank you, will check out those sites and do a bit more research on it

www.aims.org.uk/

www.homebirth.org.uk/

Well I had a big pph (12 litres + clotting agent) and I must say it was bloody terrifying and I would never contemplate a home birth after having had it just in case.

Hi fingerwoman - it sounds like your m/w is not very keen on homebirths.....

There is a slightly higher chance of PPH with a bigger baby as the placental site is proportionally bigger, but unless labour is very prolonged, the risk of a pph is not that great, and 9lb 1 is not unusually large. More relevant in your case is the fact that your bleeding came from the perineal trauma and haematoma, and not from the uterus.

So, although technically 500mls is considered a PPH (and remember that you lose this much blood at a blood donation), its not your uterus at fault, but the tear that you had which caused this. As a midwife, I would consider this blood loss to be the upper limit of normal, rather than a proper PPH anyway. Was it a 3rd degree tear - if so this may be making the m/w nervous.

If your hb is good and there are no other problems, I would not be put off by a bigger baby, have a look at some of the other threads on here and see the size of some of these hb babys who have had no probs.

Surely the m/w will carry syntocinon and syntometrine though as part of their homebirth kit?

Good luck whatever you decide

hi, thanks for the responses.

I had a second degree tear, and it was a ventouse delivery. She did say she would find out all the details before seeing me tomorrow because I coudln't remember everything that had happened.

I actually felt fine after his birth, I was anaemic and got given iron tablets but then, I seem to be anaemic a lot of the time anyway lol so not sure it was necessarily connected.

Also read online last night about a study of 40,000 home births and not one person died of PPH! so might quote that at her tomorrow as well

more info here

Hiya, do a search on big babies/hb on here, plenty of big babies and home births. My secnd was 9lb 8oz at hmoe, sister's second was a 10lb home birth

Well when it comes to hb and pph I was under the impression that the mw are trained to deal with it, have the drugs to hand and can transfer in with you in the ambulance, with their hand placing pressure on your abdomem and the other one up your fanjo compressing the uterus to prevent bleeding out, if necessary! It's not something to be taken lightly but I think you are less likely to have a pph after a calm HB than if you have an hospital birth full of intervention. I would need to check out figures but I do know that you have 0.7% chance of hysterectomy after a CS. It would be interesting to compare that to needing a hyster after a normal birth. I need to find that out.

If it occurs in the 24hours after birth and mw have gone home from a HB, then at least dh and other family memebers are likely to be around to dial 999.

If it occurs after a hospital birth I shudder at the thought of trying to call the mw attention during the night when dh has gone home and the night shift is on... how does one press the buzzer whilst passing out? How many times have people complained of no-one coming when called? Too many times for comfort!

3 big babies (9lbs 9, 10lbs 10 and no not 11lbs 11 number 3 was early and only 10lbs 4), 2 PPHs (both substantial, transfused on both occasions). Last baby no PPH but I was being pumped full of drugs prior to delivery to prevent it happening.

Very long detailed discussion with consultant between baby 2 and baby 3 when she said she believed there was a correlation - your uterus can get over-stretched and becomes boggy and is basically knackerd and can't contract (obviously those weren't the terms she used ) plus larger baby means larger placenta site which can also comtribute to PPH.

Like PPH I wouldn't have contemplated a home birth after my first - however my blood loss was estimated at I think around 6000 ml after the my first with an HB of 3.6. I flat-lined and was very ill. (Nothing however that a few gallons of blood couldn't out right.)

Surely your blood loss was likely to be caused by the 'wound' that needed stitching thou'? Why don't you get your previous delivery notes and discuss them with your new midwife?

HTH

Hi
My first baby was 11lbs 3oz and I had a retained placenta and pph and needed a transfusion. I had my second baby at home, the mw said I 'had' to go and see the consultant to 'ask' whether I could have a homebirth for no.2 because of size of 1st one and pph. I ended up seeing a registrar, who had absolutely no problem with it and I had a lovely homebirth with no 2 who was 'only' 9lbs 10oz, not much blood loss, all fine. Am planning no 3 at home and midwives seem fully supportive so far. As other people have said, seems a good idea to do some research as to whether any likelihood of recurrence of what caused the pph anyway. Mw's do have syntometrine to control bleeding and you could transfer after the birth if necessary.

Hi, don't agree about any link to PPh and big babies, my dd1 was 5 weeks prem , weighed 4.4 lbs and I had a 1.5 litre PPH - well managed in theatre by consultant ( this was overseas) when pregnant with dd2 I metioned to MW about having an Iv inserted during labour just in case and she poo-poo ed the idea and said it wouldn't be needed and wasn't routine for past PPH ers to have managed stage 3 ( she even mentioned a home birth) as it was dd2 was 9 lbs , i had an abruption, bled out in theatre and had an emergency hysterectomy . I can safetly say i think MWs talk bollocks most of the time. good luck with whatever you decide.I would think you blood came from your heamatoma tearing than from a PPh but obviously i would want a consultant to look at the notes prior to making a descision.

well, I am seeing her tomorrow and hopefully she will either have, or have read, my notes from DS's birth and be able to enlighten me on a few things.
I really do feel positive about this though and am planning on going ahead with the homebirth.
it's been really good to hear everyone else's experiences and advice