PPH in 1st birth. 2nd birth C-section or natural?

[pizzanoodle]

Hi everyone,

I am 29 weeks pregnant with my second baby.

For my first (about 3 years ago), I had a natural delivery. I had PPH and lost 2 litres of blood. There was no reason identified but my labour was long (25 hours), the epidural didn't work well, I had a tear and a forceps delivery so that might have been the combination of reasons.

Now I'm considering whether to have a c-section or a natural delivery for my second. What were your experiences? What did the doctors say in terms of which one is better for someone whose had PPH before?

I spoke to a consultant at my 20 weeks scan and he did not mention anything about a consultant-led unit or any preparations (cannula, oxytocin etc.) for PPH for the second delivery. I found all of these via mumsnet / Internet myself! And all of that makes me quite concerned about going in for a natural delivery as I don't know if the hospital staff are prepared enough for that. Should I therefore go for a c-section where the delivery will at least be more controlled and at the hands of experienced surgeons?

Thanks in advance for your responses!

Best Wishes,
Mel

Hello! I had a small PPH but massive tear with my first. C section with my second and had veins in the wrong place so lost half my blood as they had no choice but to cut through them, so it's not a guarantee that you won't lose lots of blood again. BUT I LOVED the experience of a c section, it was soooo controlled, blood was going into me as it was coming out, they are so prepared and calm and kind in there. I had another c section after that one, which was absolutely textbook and glorious. I am team section, it just takes out so many unknowns.

I had 3rd nearly 4th degree tear and torn uterus and PPH first birth. Second I had ELCS and it was an absolute dream very 'healing'. I recovered far better from ELCS than I did my tear. My consultant whole heartily agreed with my decision for ELCS and was fully supported

I had an ELCS after a PPH, foreceps, huge episiotomy etc etc. The ELCS was an absolute dream in comparison, so calm and easy, I loved it!

PPH first time (controlled very quickly and I was able to go home the following day). Second birth it happened again and was worse (had to go under GA).

I'm pregnant again and have a consultancy appointment on Tuesday to discuss options but apparently a c-section can bring more blood loss than a vaginal birth according to my midwife.

It's a hard choice to make but you do what you feel is right xxxx

I had a PPH after my first birth (I lost about 1.5 litres I think, and like you there was no specific cause identified) and it never really came up in my second pregnancy. I was referred for a consultant appointment because of my low weight pre-pregnancy, and she mentioned it but was happy for me to give birth wherever/however.

I ended up being induced at 37 weeks after my waters broke at 34, and I don't think my previous PPH was mentioned at the hospital. I wasn't aware of any special measures (if that's the right term). Although I had a cannula in anyway, which they put in in case they needed the drip to induce me, and to administer IV antibiotics. And I had the injection to deliver the placenta, but I think I had that in my first birth as well. I didn't have a PPH the second time.

You can have a PPH after a c section, so I guess it depends on individual circumstances (as in, maybe some risk factors are more likely to cause a PPH after a vaginal birth than after a c section, but I don't know), and personal preference.

I had PPH with first (although I didn’t lose as much as you) and had a natural birth with my second but no PPH. Epidural with first, failed epidural with second. Long labour with first (39 hours from waters breaking), short induction with second. Oxytocin with both.

PPH with first child. Lost 2.5l. Likely linked to low lying placenta (2 x big bleeds at 35 and 39 weeks)
Vaginal delivery with second child and a calm uncomplicated delivery. I was given a cannula when I arrived on the delivery suite and the consultant recommended oxytocin following delivery, which I had.

I also had PPH at first birth, lost 2.5 litres after long labour, forceps and episiotomy. Bleed apparently came from the episiotomy.

Currently pregnant again and was in a similar conundrum, though I worried that with an ELCS there was more opportunity for bleeding!

Had a consultation with hosp and they recommended cannula and additional medications at birth - but also said given it's a second vaginal birth it is less likely to go on as long or require assistance, therefore less likely for the same to happen again. I found it reassuring and likely to go for the vaginal again.

I had a PPH after a cs so it’s not a guarantee.

Can you ask to see a consultant midwife to come up with a plan for the birth & investigate different options?

I had a 7l PPH and ITU admission with baby number 1, thought to be due to sepsis so theoretically unlikely to happen again. But I chose an elective section for baby number 2 simply because I thought I would be so anxious and tense that a natural birth for number 2 would be a miserable experience and my anxieties might actually make me so tense that it would make it less likely for everything to progress normally. The elective section was perfect - I felt safe and calm in the hands of the consultant who did it and I got home 24 hours later. So no regrets - it was definitely the right decision for me.

C section. If they know you're high risk for a PPH (I was) they can get you in early and have everything required on standby - transfusions etc. I had a very similar sounding first birth to you, 2l PPH, 46 hour labour, forceps / failed epidural etc, and my C section was just heaven in comparison. Provided you stay on top of medication, I found the recovery much, much easier than with my "natural" birth!

@Weepingskies 7 litre PPH? Most adult humans have 5 litres of blood in their body.

I had a huge (3.5l) PPH with first. Lost consciousness, crash team, blood transfusions and over a week in hospital.

Quite frankly was terrified second time round but was consultant led and given a cannula and oxytocin during vaginal delivery. I did actually have a small PPH (recorded as 1.5l) but recovered well and was home less than 24 hours later.

Third baby and I had a planned section as they were an awkward breech and wouldn’t turn. Honestly, I found this recovery the hardest and not being able to drive was tricky with 2 other DC needing to go to nursery and school but we managed.

Most important thing of course is baby out safely and Mum well. Maybe have another chat with your midwife and consultant. The cannula and oxytocin being in place is a good idea.
Good luck with what you decide to do x

You're more likely to have a pph after a c section than vaginal delivery. I'd go for another vaginal birth if I were you. It's worth talking to an obstetrician if you can.

https://www.chop.edu/conditions-diseases/postpartum-hemorrhage#:~:text=Postpartum%20hemorrhage%20is%20excessive%20bleeding,after%20the%20placenta%20is%20delivered.

I had a PPH with didn't and most 1.5l of blood. Second I was at a different hospital and had a meeting with the consultant where he said they would give me a drip of something to help stem the bleeding after delivery. I was there for about 2/3hrs on the drip and all went well.

Not sure if it was as of the meds but I didn't even bleed for as long with second.

@justanothernamechangemonday I know! They kept transfusing blood in - I had 14 units in the end as well ax 2 units FFP and 2 units platelets. It was very scary and very surreal- especially as I’d only gone on mat leave 2 weeks before from my job as an obs and gynae junior doctor so knew everyone really well!

I had a big PPH with 1st baby, 3 day labour, episiotomy, ventouse etc... Was absolutely petrified for 2nd baby but everything was straightforward this time, much easier birth and a much faster recovery.

@Weepingskies Christ. Can't even imagine.

Didn't lose as much as you but I had a pph with my first after a long labour, failed epidural, forceps. I had an appointment with a consultant midwife to discuss options for my second. They said it was unlikely to happen again as mine was due to a bad tear from the forceps. So I would definitely get someone to go through the notes with you as the reason is really important.

I opted for natural again. 100% the right choice. Really quick labour and straightforward. Minimal blood loss.

3L PPH with my first. It was awful. Forceps, retained placenta, foetal distress, long drawn out labour that lasted 36hrs. Then I had to have a GA to remove placenta, undo episiotomy and suture it back up properly. I felt a failure.

Elective caesarean with my second - it was bliss. I recovered a lot quicker than I did with my first. It was also quite healing emotionally.

Thanks everyone, all of these were super helpful! We have decided to go for an elective c section. Fingers crossed it will be smooth and easy.

Hi @pizzanoodle just wondering how it went for you? I’m 21 weeks with second baby, with first had elective section but had PPH (4 pints), transfusions and then sepsis 😩 I’m having another elective this time but terrified of same thing happening even though consultant has said they’ll give me various drugs to help uterus contact effectively and prevent blood loss. Just looking for experiences really to help me prepare :/