Previous retained placenta, but hate the idea of another hospital birth

[PhDMum]

With my first child, I had a retained placenta that required manual removal in theatre with an epidural. I strongly suspect that the fact that I was induced contributed to the situation, but my consultant insists that induction has no effect on retained placenta rates. I was induced at what the hospital insist was week 41 (2weeks over). In fact, I am certain about the conception date, and was only 1week overdue at the time. (I would never consent to induction again except in the direst of emergencies).

I am currently 18wks pregnant with my second child, and have been told that I have to go in to the consultant unit for this birth. The consultant has given the reason that though retained placenta is normally only found in 1/200 births, because I have had it happen once, my chances are now more like 1/3 of it happening again. For reasons of safety he insists I go to the main hospital. I really don't trust his statistics, as they don't tally with other info available online. The consultant unit is over 40 miles from my home, and my partner can't drive. Men are not allowed to stay overnight, even if their partners are in labour. I desperately want my partner to be at the birth of this child, and I know that if I am forced to go to the main hospital then that is unlikely to happen. I want to have this baby in my local, midwife-led unit (40 miles from main hospital and Consultant unit), but I have no idea what the true level of danger to myself or my child would be if I insisted on this, or if I can demand it - they seem pretty certain that they can dictate how and where I give birth-

Can anyone help?

phdmum- i had a retained placenta with dd1. It was a pretty grim experience coming after a long labour, hormone drip and ventouse delivery.

2nd time I had home birth-and had a physiological third stage too (had to be pretty stubborn about that bit, mind you).
The first midwife I saw was not encouraging about having home birth, the ones I saw later on were fine about it. I had to see a consultant at some point and he said if I were his wife he would make me have a hospital birth but I was pretty determined and told him so.
So no, they can't force you to do something you don't want to do, only advise you as far as I'm aware.

i would say though that I live very close to the hospital so I had the security of knowing I could be transferred quickly. having said that as far as I call, it wasn't really an emergency situation with the retained placenta first time around- there was a fair bit of hanging about before I went into theatre (dd1 delivered at 10.30, was not in theatre til gone midnight at least.

have to say, the community midwives were very laid back about the possibility of retained placenta happening again.
I had heard chances of it happening again were 1 in 100, not 1 in 3...

Thanks CatIsSleepy.

My retained placenta wasn't that much of an emergency either - I had my little girl at 01:18, but wasn't out of theatre until well after 04:00 - I wasn't keeping track, but I think it was a fair while before I got transferred to the theatre in the first place. Apparently there is a danger of haemorrhage if the placenta is only partly retained, but that doesn't always happen.

I'm really in two minds. The distance from the hospital is a worry.

Unfortunately all the midwives in my area seem to consider this particular consulant as a type of god, and not one of them will do anything against his wishes - meaning that I don't feel like I have much choice or the luxury of an impartial opinion.

I think you are right about the 1 in 100 stat as well. That is what I can find in reliable medical journals -which makes me quite angry, as I suspect he is making figures up to try and scare me into doing it his way. It is actually quite insulting to my intelligence, and certainly doesn't inspire trust. Obviously he thinks that Hospital is the right place for me, and I don't think he is being deliberately obstructive - but it does leave me unsure.

I think I'll have to talk it over with my partner (again) and see what he thinks.

I think probably all consultants think women should give birth in hospital!

but do talk it over more with your partner

i am not one to go against medical advice ( am probably the least rebellious person I know) but in the end i weighed it up and came down on the side of wanting a home birth- I think i felt for some reason the retained placenta was unlikely to happen at home. Ok that makes no sense at all-um, I think i thought a less medicalised birth procedure would make it less likely IYSWIM...it seemed the culmination of a sequence of events... (but I could be very wrong about that!)

You have to do what you feel comfortable and safe doing x

Similar experience to me.....forced to go to consultant unit following first birth with non emergency retained placenta. Just given birth with second, all fine, no repeat. I was told by the midwife unit after that if I had put my case forward and been stubborn it is likely that I would have been allowed to have the second birth at midwife unit.

Fight for what you want, after all you will find birth is easier if you are happy where you are. I certainly will not be having my third anywhere but the midwife unit and will go for a home birth if they refuse. Good luck and be determined.

thanks beckynbump.

Good to hear that your second was a better experience.

I suppose if they are really awkward about it, I can always leave things v.late and turn up at the Midwife Unit doors at a point in labour when it would be too late to try transferring me...

It is a funny system that lets you demand a home birth, but does its best to cram you onto an overcrowded ward in a highly medicalised environment where intervention is the default setting. I'm all for compromises myself, and much prefer the idea of the low-key midwife led option.

I may try demanding a home birth, to see if they will meet me half-way (with the option that actually want).

Anyhow, thanks for sharing your experiences - it has given me a bit more confidence.

Have you thought about getting a copy of your notes from the first birth. Knowing what type/level of retained placenta you had might help you make your choice?

After DC3's water birth, no induction or interventions during labour, I had a morbidly adherent placenta which no matter where I'd given birth would've required a trip to theatre. From my follow up with the consultant I understand that some placentas are more "stuck" than others and hence have higher risks associated with bleeding etc and chances of repeat problems.

I agree with Cat, you have to do what you feel safe and comfortable with.

swissmiss - getting hold of the notes is good advice, and yes I have considered it, but I have held off so far as it seems a bit confrontational. (Which I know is silly, as everyone has the right to their own notes).

From what the consultant has said this time, and what I remember, my placenta was completely stuck. They spent quite a long time tugging at the amniotic sack that was visible, tearing chunks from it and causing me incredible pain in the process.

Oddly enough, a total retention is actually less dangerous than a partial one - it is when a part has come away but some is still attached that you run the risk of a life threatening heamorrhage. I was never in any danger of this, though a trip to theatre was inevitable.

Unfortunately, I don't think past experience is any guide to future recurrences in terms of the details with retained placentas.

It is really hard to make any sort of decision. If I am honest, I don't think I am going to feel either safe or comfortable with any result. If I demand to have my own way, then I will be terrified that something will go wrong and it will be my own fault. If I just allow the professionals to railroad me I'll be left potentially with no birthing partner, and feeling very lonely and totally out of control.

It sounds like your local NHS is a bit better set up though - 'follow up' is not something offered around here with the consultants. I think that if I had been told after my last baby what I have been told now, in the run up to the birth of my next - then I would have taken a lot more precautions and made sure that I stayed with just one child.

PhD - what you say about totally stuck vs. partial makes logical sense wrt heamorrhage. Thinking about it I was referring to when the cervix has closed before the (self)detached placenta has delivered, so it was never actually "stuck" to the uterus, just had it's exit route already removed. I understand this also counts as "retained" and once the spinal/epidural is in the cervix relaxes and the placenta can be "easily" removed.

I like your idea that my local NHS is better set up, unfortunately not. Follow up only happened because I was so traumatised by my experience and was not seen by a dr before I was discharged I had no acutal understanding what/why things went "wrong". My community m/wife got me a post natal de-brief appointment 10 days post partum as I was in such a state. I have a big thing about how badly I was treated and am currently on the NHS waiting list for trauma counselling/therapy (it'll be over 1 yr after my GP referral before I get any "treatement" and 18mths after the event - but don't get me started on that vent! )

The main comment the consultant made re. where to have any future births was "we wouldn't allow you to have a home birth!" which seems to be along the same line your consultant is pushing. I didn't get any further info as I'm done at 3 DCs.

As you say, it is difficult to feel safe or comfortable with any result. Are there any other mid-wife led units nearer to the hospital which you could consider, even if they are overall further from your home than the main hospital? Say a m/w unit 50 miles from home but therefore only 10 miles from the hsopital. Hope that made sense. Another random question - your main hospital don't let dp's stay overnight - is that when you are actally in the delivery suite or just on the ante/post natal wards?

Wow, that turned into a bit of an essay.

What makes you think the induction contributed to the retained placenta? If it stuck because it was adherent then it actually penetrated into the uterine wall and I can't see how any labour intervention could cause that? I realise that is only a wiki link but it sums up what i've read elsewhere. Apologies if that question is out of place, it's just got me thinking about it all again. Guess it might be another reason to request your notes.

Hmm. You have given me plenty to think about there Swissmiss.

First of all - I am so sorry to have jumped to conclusions about your experience. What happened to you sounds truly terrible, and I hope they treat you a bit better in future.

You are probably right about me getting hold of my notes. As far as I know, although my placenta didn't detach as it should have done, it wasn't a case of Placenta Acretia. In the theatre it was just a matter of an epidural and a surgeon jamming her arm in and hauling at it - no actual surgery as such. (By the way, just a tip for anyone else reading - if you ever find yourself in this situation, DO NOT look up at the theatre lights. The mirrors surrounding them reflect everything, and the image of a stranger with arm length marigolds on dragging the bloodied remains of your afterbirth from you is not something you want to have to live with). However, without the notes you are quite right that I can't really be sure about the severity.

On your other point, there is a midwife led unit attached to the hospital, and they have offered to let me go there and then transfer me to a delivery room at the critical point. I'm considering this, but I need to look into the set up. I won't know any of the staff and I have no idea how it works there.

The main hospital consultant unit will let partners stay IF you make it into a delivery room before the end of visiting hours. However, it is often so busy that women have to give birth on the wards. Most babies are born fairly late at night, and there is generally a long queue for the proper delivery suites. If you get moved to a delivery suite after visiting hours are over, you are at the mercy of whether they have anyone free to call your partner for you - and how long it takes your partner to make it to the hospital. By a fluke, last time my partner made it just 20mins before our little one was born. (After about 8pm there is no public transport and taxis are fairly few and far between). At 4am when I came out of theatre he was thrown out of the hospital with very little warning, and had to walk for 1 1/2 hours to the train station to wait for the first train of the day in order to get home. He has since been seriously ill (unrelated!) and is not in any condition for me to ask him to go through that again.

The induction-related-to-retained-placenta theory is possibly a bit far fetched, but there is suspiciously little published research on this subject relating to humans. I personally feel that if you rush things faster than nature intended then you are likely to get problems. And whilst I have no medical evidence to back it up, I definitely think that in my case the placenta was just not ready to detach because my baby was not ready to be born. I was only in proper labour for about an hour, because the induction drugs were so powerful - it just didn't seem like long enough for my body to react in the right way. I also get the feeling it is not a subject that obstetricians want to delve too far into, as induction is such a convenient tool. I'm probably sounding far too much like a conspiracy theorist by now - if you have made it reading this far!

I think I will be asking for a copy of my notes, and perhaps having a look at the midwife unit attached to the hospital, anyhow. If I'm really lucky they might be a bit more relaxed about letting partners be present at the birth...

No need to apologise PhD, but thanks anyway. I'm with you on the don't look at the lights. A sheet at waist height would've been a nice touch, at least then I'd've been able to look straight ahead without seeing said sight. I didn't have surgery as such either, just the dr manually sawing back and forth with her hand for 40mins to get all of it detached. Having expected "surgery" i.e. some medical implement to be used to remove it the whole James Herriot and calfing scene was rather unexpected. Even my consultant compared the procedure to a vet and cows. Which really helped me, not!

The overall lack of information and research is frustrating, it certainly dosen't help one make an informed choice on the matter. As yours wasn't placenta accretia I can understand how you're making the induction/retention connections. Doesn't sound like a conspiracy theory to me, more like you unfortunatley had "trigger/induction happy" drs around you.

I've had 3 DCs in two different hospitals. DS1 in m/w birth unit attached to main hospital, DD1&2 in consultant let unit at different hospital where I had complete midwife led care and only saw the drs who had to put the cannula in for my Group B Strep+ antibiotics. (Obviously until the whole lack of stage 3 with the last baby) For me the best care was actually at the hospital unit which goes against most peoples expectations. With all 3 I never knew any of the staff beforehand as there is no named midwife care system here.

Have a look at the m/w unit attached to the hospital, you never know, it might be the acceptable medium you're looking for. The policy for partners at the main hospital sucks imho! Good Luck.

Sorry to put a negative post here but a friend of mine had retained placenta with 1st birth and again with 2nd birth and almost didn't make it through....
do think very long and hard about the risks as it can happen a 2nd time and my friend's dh had a period of thinking he might have gained a son and lost a wife

negative posts are as welcome as any other - honesty is the only thing I ask for. I really hope your poor friend made a full recovery after that terrible experience, displayuntilbestbefore.

This is the reason that any decision is hard to make, though. The risks are massive, but I don't really know how to properly quantify them. All births involve risks, including the risk of retained placenta. But in most cases, the risk of retained placenta is about as high as that of stillbirth/death of the infant in the first week. Nobody is telling all women that they must be hospitalised because almost 1 in 100 babies in the UK dies either at birth or in the first week of life,(seethis) because that is considered to be an acceptable risk. (If you don't count consultants, who actually do want all women in hospital).

Equally, all women face choices about what level of safety they feel happy with. Because I'm not inclined to believe my consultant on his 1/3 statistic, I have very little idea what the actual risk involved in my case is.

I think I will eventually end up choosing either in the midwife led unit or in the consultant unit at the main hospital, and just dealing with the fact my partner probably won't be able to be there.

I think a lot of my worries are probably accentuated by pregnancy hormones at the moment. It really feels like because things went quite badly last time, I'm not even going to be given the chance for them to go right this time around - which is a shame, because up until my appointment with the consultant I was quite positive about this pregnancy. I am now dreading giving birth. Whether it goes smoothly or not I know it is going to be another disgusting, painful,degrading, de-humanising experience over which I have no control.

Still - there should at least be a georgeous baby at the end of it all. Which is the most important bit, I guess.

swissmiss - no sheet is positively criminal, have you thought of suing them?

I had a partial retained placenta with DD1 and a pph. Very traumatic and DH also thought he was losing me.

It wasn't mentioned during my second pregnancy and it didn't occur to me to worry about it second time round. DS2 was born in a home from home unit without problem.

However I again had a partial retained placenta with DS2 - there was no anaethatist available to give me an immediate epidural for theatre and so it was manualy removed by a Dr in the delivery suite. Not nice.

PhDMum - thank you, yes she did...but sent dh off for vasectomy pretty sharpish as terrified of another pregnancy!
Good luck when due date arrives and I can only sympathise with all of you who have experienced this as I can only imagine how traumatic it must be and until my friend had her experiences I'd not been aware of the condition.

PhD - honestly no I haven't. As yet haven't even manged to make a formal complaint which my logical brain tells me I should.

Tinkerbellsmuse - for you. Sadly you're not the only person I've heard having a placenta removal with no anaesthesia.

I know my DH was left alone in the Delivery Room with DD2 thinking that he'd be bringing up 3 DCs alone.

I have looked back at my last post, and am really quite embarassed. I think the hormones rather took over that day. In the scheme of things, I'm really not that badly off.

Tinkerbeleesmuse - your experience really puts mine into perspective. No anaesthetic is just too horrifying to contemplate. I know that whilst I was still in the delivery suite and they were trying to remove what they could, I was in a lot of pain - but nothing compared to what you went through. I was so sorry to hear that you had to go through that.

I remember one member of staff telling me that it was 'only the afterbirth' and that it 'couldn't be hurting'. There seems to be a misconception about this among medical staff. They give the epidural in order to relax the cervix - not primarily to relieve pain. I think perhaps there needs to be some education for midwives and doctors on this subject. I for one can vouch for the fact that it is a very painful experience- and I had the epidural fairly early in process!

I had a retained placenta with dd, ds1 was an emergency section and retained placentas are common after sections, and would quite possibly lost ds2 and myself if I hadn't been in hospital.

I think you need to think more about the end result than how you get there tbh as you seem very angry.

Where the bloody hell is your hospital, 1940 ? I cannot believe they would throw husbands of labouring women out of the maternity unit !

My husband (a detective sergeant) has said there will be no way anyone will be making him leave when I give birth and they can call the police if they like - cos nobody will come out to remove the husband of a woman in labour.

PhDMum - So what if hormones took over that day? You did say they were playing havoc. You are pg. Not meaning any disrespect to any other poster, how your last experience left you feeling is what matters to you. I for one am not trying to one-up anybody in the how awful was your experience stakes. I'm sure some people who went through what I did would've come out relatively emotionally intact but I didn't.

As CatIsSleepy and I have said previously, you have to choose the place where you feel comfortable and safest. Good Luck.

PhDMum
thanks for this thread!
I had a retained placenta with dd2 and i like you was induced and that and the combo of m/w pulling to hard on cord and it breaking were huge factors
With dd1 I had no problem at all.

I would LOVE a home birth LOVE LOVE LOVE but my consultant is very anti homebirth and tbh my dh is anti too as he is worried about placenta probs..

Watching this thread with great interest!

I am now 35 weeks so I am on final countdown now.

I had retained placenta, and am about to give birth to second baby. I have been recommended by my midwife, and others to ask for physiological third stage as this actually reduces the risk of retained placenta. If after 1 hour it does not deliver on its own, I can then have it managed with oxytocin. I have in HUGE lwording on my birth plan that I wish there to be a MW who is experienced at physiological third stage and that they are under no circumstances to pull on the cord. Consultant of course thinks I should have a managed third stage but could give me no reasons, other than to suggest its easier all round. My MW was very supportive when I said I wanted a natural third stage, and said she agreed it would increase the chance of natural delivery.

I have been consultant led all through this pregnancy, and at my last visit at 36wks I was put back to MW led care, and told if I wish to have a home birth i could, but be prepared that if the placenta failed to remove after 1 hour I would be given oxytocin and required to be moved to hospital for the removal. Same if I bleed excessively.

I have in fact decided to go into hospital, but with express wish to have them leave my cord well alone til the placenta is delivered. I shall then BF my baby til it comes out!

Good luck.

PhDMum
thanks for this thread!
I had a retained placenta with dd2 and i like you was induced and that and the combo of m/w pulling to hard on cord and it breaking were huge factors
With dd1 I had no problem at all.

I would LOVE a home birth LOVE LOVE LOVE but my consultant is very anti homebirth and tbh my dh is anti too as he is worried about placenta probs..

Watching this thread with great interest!

I am now 35 weeks so I am on final countdown now.