Did I have a PPH?

[ruthmollymummy]

I'm 38+4 with baba no.2 and today my midwife (who is always coming up with new reasons why I can't have a homebirth) told I had a PPH after last birth. This is the first I'd heard!!

I knew I'd lost a lot of blood (900ml) but it was after a very long induced labour and episiotomy and forceps delivery. Nothing wrong with placenta, no vaginal tears etc. Is that still classed as a pph? I don't remember any trouble stopping the blood or any panic over it at the time.....

I'm just confused and you ladies all know so much!

Some people say 500ml is PPH, others say 1000ml. Others classify it more by how it affect the mother. If you were OK after birth that wouldn't be PPH for them no matter how much blood you lost but if you were faint, wobbly etc. then yes it would be PPH>

I think blood loss of over 500ml is considered a PPH (I lost about 1500 ml with DS which was a PPH and 400ml with DD which wasn't).

Did your iron levels drop a lot after the birth? I needed a transfusion (and lots of sewing up in theatre).

I have no idea about homebirths and previous PPHs - I have a feeling there has been a thread about it recently, but not sure what section it was in.

This thread mentions PPHs and homebirths

yes i think anything over 500ml is classed as pph.

i had one with my first baby, but still went on to have a successful homebirth second time round. and only lost 150ml that time

I (apparently) had a pph last time (650mls) but my consulatant said that's no reason not to go for homebirth this time. If it had been more (over 1000ml or so ? I guess he may have suggested I think twice, but not sure on that.....I guess they draw the line somewhere?)

I have copied and pasted the following from Angela Horn's www.homebirth.org.uk website.

To try to work out the chances of a PPH recurring, and whether this is 'safe' for a home birth, you'd need to know why the PPH occurred, and if the same circumstances were likely to recur. Usual caveat: I'm not a midwife! However, if I were, I would be wondering:

1. Was the PPH significant for her, or was it just a 'technical' PPH? eg I had 500mls caught in the dish after my first baby was born at home, plus plenty more in the birth pool, all over the floor, etc, but I felt OK and was off up the high street the next day. As a strapping lass, 500mls + clearly wasn't that bad a loss for me. On the other hand, after losing around 3 pints during a miscarriage, I felt dizzy and breathless for a couple of weeks afterwards.

Midwives on this list have often commented that they prefer to base their definition of PPH on how the woman feels - some feel awful after losing just 300mls, others recover quickly from a much larger loss. What is the definition of PPH in your hospital? Some use the old UK standard of 500mls +, while others now seem only to record blood loss over 1,000 mls, the criterion which is more common in Europe.

1. What were the circumstances the PPH occurred in? Were there known risk factors for PPH which would not apply this time? For instance, PPH is more common after assisted deliveries, first babies (I suspect possibly because more assisted deliveries), large babies, induction or augmentation of labour. If she needed an assisted delivery this time she would transfer to hospital, so that shouldn't affect her status as regards home birth. Likewise, her labour is not going to be induced with prostaglandins or augmented with syntocinon.

1. Was the PPH a 'true' PPH in terms of being blood loss from her uterus, or was it associated with perineal tearing or episiotomy? Blood from both sources ends up in the same measuring jug, but the difference is significant.

1. Was her previous PPH an emergency situation - eg lots of blood spurting out, needing particular treatment to stop it? Or was it a steady flow? How was it treated? If she was given Syntometrine, did she respond well to it? Or did she need some treatment that you would not be able to give at home?

1. Did she have a retained placenta, or did the bleeding occur after the placenta was delivered - some 'uterine atony' involved?

I have had what the medics call pph after both my births, although they where the results of forceps, episiostomeys & not as a result of the uterus not functioning well.
We are in a battle at the moment about how I will give birth to nos 3 but an independant midwive believes that if I had not been cut & had intervention I would have been OK, she has read my notes from both labours. Local MW believes I will be at risk & silly to birth at home, after reading same notes! They are very into their policy & figures rather than looking at the different circumstances.I was also well after the pphs as I am quite well built to start with.