Hosptial policy to have a c-section if you ahve had pervious pphs?

[cheesemonster]

I am due my 3rd in June & am having a realy problem with my local hospital. I am trying to get a homebirth but am meeting with every obstacle. I have had 2 pphs in my previous labours but as my notes don't say exactly but agree, not sponanteous but due to lots of intervention.
I am battling for a homebirth which everyone keeps saying I cant have as it is too dangerous. I personally feel that if I am not in hospital & labour is pregressing well at home then I will be OK & only have PPH due to lots of cutting etc in hospital.
Anyhow today I have had a letter from the hospital saying I have to see a constulant. Have called up to ske why & found out that it is to discuss me having a booked section The midwives have now told me that it is hospital policy to book sections if a woman is at risk of a pph...... What?????
Does anyoen else have any experience of anything similar? I am pretty at the whole situation.

I had a pph with DS and no one suggested that I should have a C-section when I was pregnant with DD. I would be as well tbh.

With DD I had a natural delivery, no stitches and it was fine. I did lose quite a bit of blood (400 ml) but compared with teh loss of 1500ml with DS it was minimal.

Have you seen the homebirth website? They have a page on PPH (got to "you can't have a homebirth because..." and then look for "You have a previous post partum haemorage").

Nuts and bolts are that it's your baby, your body and your choice as to where and how you have your baby, and what appointments you have before hand. If you don't want to see the consultant you don't "have" to. If you want a home birth you don't need their permission. In the words of Mary Cronk, "Allow is not a word to use to a mentally competent adult."

That's not to say that I think all medical advice should be disregarded, but I do feel that ante-natal care can become more about following hospital policy and getting women to do what they're "supposed" to do rather than allowing them to make an informed choice and then supporting them. I wound up using IMs as I felt my CMW was unsupportive of homebirth, and was doubly glad when it turned out she was breech - she was born as a breech baby at home at 41+3 and I had a very good experience.

You might also find the homebirthUK mailgroup and AIMS very supportive and able to give you some very good advice.

Fingers crossed you can get things resolved and have a birth you're happy with

OMG, I can't believe that!! (well actually I can, but am very saddened to hear that you are being spouted such sh*!)

You rightly say that the use of a lot of intervention is previous labour is a possible reason for having a PPH. Other things to consider are: How much blood did you actually lose? A PPH is classed as 500mls which is actually hardly anything and most women would cope fine with this without any need for transfusion or anything. I have seen women lose 1500mls and be absolutely fine afterwards and I've seen women lose 300mls and feel like crap afterwards. It very much depends on the individual and the circumstnaces.

Also, where was the blood loss coming from? Was it from being cut/having torn? Was it from your uterus not contracting down hard enough afterwards? Or was there some other problem found afterwards meaning that your blood would not clot?

If it is because of your uterus not clamping down quickly enough then the drugs used to counteract this are the exact same ones that re used at homebirth and they are very effective. If you are having a look at the homebirth website, I wrote a piece for Angela on dealing with a PPH at home which should still be there.

I had a PPH with my second labour. I was at home, had an injection of syntometrine and it stopped. I was fine if a bit wobbly.

I hadn't even considered they might not let me have a home birth next time let alone insist on a section.

I hope you manage to duck the beaurocracy. It's just them covering themselves but I don't think they have any right to enforce this.

Meant to add that the highest risk for PPH is................having a section so a bit ironic really isn't it?!

That is so weird - I had a large pph with my first (which was an emergency section) & am at increased risk of further pphs because of medical complications. I was actively encouraged to consider a VBAC by my consultant though - there was never any suggestion I had another section because of the pph.

I cant get my head around it really! Thanks for infor Howdie, will have a look at the website but I bleed cause of cut, nothing to do with uterus not clamping down etc. lost 1500 ml 1st time & 1300ml 2nd time but didnt feel too bad after it. I have explained to my CMW that if I was a tiny size 8 then would probably have flet rough but as a stocky size 16 it didnt effect me as much. She coiuldnt get her head around what I was saying.
We are now scrabbling around to see if we can get money together for a IMW- I dont see why we should have to pay but cant really face doing huge battle.
Very intersting about sections & PPHS though

my friend had PPH first time and a home water birth second time. she did have another PPH and was transferred in, but it was under control and she was fine by the time she got there.

a section could potentially lead to blood loss too !

it sounds like a great way to get their section rates through the roof!

i would decline it, personally, surely if you have had two PPh, then your caregivers will be on notice this time and will monitor you v v carefully

if you had a long, augmented labour and a big baby, then your risk of PPH is increased

Yes, but go and see the consultant anyway. If you want to do something "against policy" a consultant's word is law to allow it to happen. They might be a sane and rational person who is on your side (some of em are!!) They can't force you to book a section but they might be the one who gets the CMW off your back.

I saw a member of the consultant's team after finding out for sure DD was breech. I wish I hadn't bothered - I think I was better informed than they were about a lot of the issues and I just got very frustrated, which did very bad things to my blood pressure.

Not all consultants are like that, its true, and if you have a supportive one it would almost certainly make your life with the CMWs much easier. But if they're not pro-homebirth or not so well informed it could swing the other way.

If you do choose to keep the appointment you might want to take someone with you for support. Mary Cronk has some more useful tips that are worth remembering include:

• Asking the consultant to repeat something that you feel is contentious.

• Taking notes.

• Asking for the spelling of their name and their GMC number.

• Not being bulldozed into a decision there and then - say you'll think about it and get back to them.

• Saying that you will consider any further discussion of an issue as harassment.

• Asking for the references to back up any statements they make (such as why they recommend a CS if you've a previous PPH) - publication, author and date.

I wish I'd had a hard copy of these thoughts with me - even though I was irrate and should have been up for much more a discussion I got a bit overwhelmed by the whole situation and just sat and fumed...

Re. IMs, the only thing I'd have changed about my whole pregnancy and birth would have been to have booked my IMs sooner. Even though I didn't sign up till 36 weeks, the reduction in stress in the last few weeks and the level of postnatal care meant we'd still say its the best money we ever spent. Its also worth asking whether they're interested in payment in kind or have any kind of payment plan - I know one of mine was really hoping someone would offer decorating services in liu of money. You loose nothing by asking.

I had a PPH with my ds1 they think it was caused because of the induction and a huge placenta surface area (or something like that)...i had 2 other inductions after and was left on the syn....drip! for an hour after to help contract uterus (wasn't nice-mini contractions)..still heavy bleeding but not too serious.

I also had to sign hysterectomy consent forms before the inductions and before 2 c-sections just incase they couldn't stop the bleeding...but everything went fine and no hysterectomy needed.

Hope you can get it sorted.