PPH - Advice and options

[doodlexyz]

I'm hoping there are some mums here that have experience of PPH's and the options after multiple PPH's.
I'm a mum of 3, pregnant with baby 4, and now worrying. I'll tell my story first...

DD1 - I ended up being induced at 41+5, once I got going, labour was around 8hrs, I had an epidural, so quite relaxed, and pushing of around 30mins I think. All well, no problems. I felt a bit weird for a few days after, which I'm told was most likely from having the epidural.

DS1 - Arrived 40+1. Went into labour at around 4am, very manageable contractions, decided at about 9am to head to hospital, got there at 9.30am. Asked for pain relief, none available as I was 8cm dilated!! 27mins later, with literally 2mins of pushing baby arrived. This is where my problems started, I had a fairly major PPH (600ml loss), and the drs/midwives were running round like loonies trying to get a drip into me, for about an hr is was like an episode of casualty. Very traumatic, and didn't get to hold my baby for all that time. Managed to not have a transfusion, although I felt awful for quite a while, but managed on iron tablets and iron rich food. At the time I just wanted to get home. All well with baby, and no lasting effects on me.

DD2 - This pregnancy I was under the consultant due to the last birth. Had a couple of appointments and growth scans, but no real plan put in place as such. Although my midwife was fantastic and made sure in my notes that I had a venflon put in during labour just in case, and that things were in place in regards to a PPH.
Anyway, I ended up being induced at 41+3. Labour lasted around 5 hrs, again easy time of it really, until last 1/2hr, and once again pushed out in 2minutes, literally! Again I had a PPH (1000ml loss), but it was a lot less traumatic due to my fantastic midwife, and was managed a lot better. Again I got away with no transfusion. But obviously blood loss was more this time.

My concerns are that I am going to have an even more excessive PPH this time. I really don't know what is the best way to go? What options do I have? I've began to think maybe its the quick pushing that causes the bleed, so maybe epidural might help?

Also just to confuse things more... I want to be sterilised, so did think maybe an elective CS might be the way to go, then I could be sterilised at the same time. But from research I've done CS is probably more likely to cause PPH!

Can anyone help? Confused and worried?

Has your consultant said anything regarding best plan this time in view of your past experiences?

I had a long labour first time round with 1.5 hours of pushing followed by a PPH, 2nd and third dcs were both quick couple of hours labour with only couple of pushes and no PPH with either of them.

I haven't had a consultant appointment yet thsi time around (currently 15wks). I know its early to be worrying, but I can't seem to think of anythign else!

I forgot to add as well, all babies were on the large side:

DD1: 9lb 6oz
DS1: 10lb 10oz
DD2: 9lb 13.5oz

I'm presuming this has an impact on it too.

Were they worried about you having a repeat PPH after the 1st one?

I had a substantial PPH after DD due to retained products. I had evacuation of placenta under GA and a transfusion.

My next two births have been elective sections with no blood loss above the ordinary.

The lady who was in theatre be

oops

The lady who was in theatre before me was having an elcs due to a previous PPH with her twins. She didn't have any additional blood loss that next time either.

Good luck

No there wasn't any concern during my 2nd pregnancy and no different plans were made for delivery. There would not have been time for me to have a venflon in case because ds2 came really fast and only just made it through the doors at hospital. I think in my case it was because my contractions were not that good during my first labour and my uterus did not contract as well as it should after the birth. when I had dcs 2&3 contractions were much more efficient.

Thanks suwoo, maybe cs is a possibility then, I'm hoping to get myself armed with info for my consultant appointment!

singsong I think that is why my 1st PPH was so traumatic, I'd literally only been in the hospital for less than 1/2hr before I needed to push, in fact I was still hooked up to the monitor when I gave birth.
Luckliy the 3rd birth I was induced, so was definitely a lot more controlled, but that didn't stop me having an even bigger bleed! Bit stumped as to why it's happened, it's not like they were identical births.

Thanks for the info though ladies, it all helps

I had a 700ml PPH after having dd, was only given a saline drip, and when i was pregnant with ds my midwife had measures in place for me to have a blood transfusion straight away if i had another PPH, i didnt need it but i think i got a blood clotting injection just seconds after ds was born.

Silly question but do you have red hair?

clayre Did you bleed at all in the second birth? And no, I don't have red hair, is there some association?

My friend (who does not have red hair ) had 2 PPH's. The consultant told her it was something to do with follicles. I can't remember where the follicles were though

That was useless wasn't it. Sorry. Want me to ask her?

lol... If you wouldn't mind suwoo, I would much appreciate it

my midwife said redheads are more likely to have a PPH and im a redhead, thats the only explanation i got!

I had a 'normal' bleed after my second birth apperntly, i remember i kept looking under the sheet they covered me with they wouldnt let me put pants and a pad on just had a mat thing under me so they could monitor the bleeding.

This and this are a good source of info on risk factors, management of PPH etc

Yes big babies (>4kg) are a risk factor, as is a CS - so that's not always the best answer.

I had a PPH with both pregnancies.

First delivery was an em c/s, PPH approx 1000ml, No major panic at the time, ended up discharged with iron tablets as was anaemic. No mention of any special measures required with next pregnancy.

Second delivery was an el c/s, PPH was 2400ml over a 4hr period after delivery . Pumped full of umpteen drugs, etc, James Herriot style manual removal of clots twice .Theatre had been prepared & I had signed the consent form & warned hysterectomy was likely when the consultant finally stopped the bleed at what was the "last attempt" before a return trip to theatre. Phew

Twas only the next day when I truly realised how scary it had been, not that many years ago I would have been a statistic

Luckily I'm not planning any more kids

I'm assuming you are under consultant care with your history? If not ask your m/w to refer you & explain why. I'd discuss the plan A, plan B etc with them.

forgot to say good luck

also big baby was definitely a factor with my second, DS was 10lb10.5oz

Apparently big baby = larger placental site + often less "tone" in the uterus due to how far it's been stretched = more area for blood loss + slower to "clamp down" after delivery, not a good mix.

I had a 1500 ml PPH with DS (DH "helpfully" told me afterwards that they had buckets at the bottom of the bed trying to catch the blood ).

He was only 6lb 1oz but I had a forceps delivery and had an internal tear. Was quite weird afterwards as the doctor was trying to work out where exactly the blood was coming from and starting swearing about the lack of useful light in the delivery suite which presumably was trying to have mood lighting or something.

I was taken off to theatre and given an epidural and sewn up for the next couple of hours. Had a transfusion later on that day (DS born very early in the morning).

I was worried during pregnancy with DD - tbh no one really listened to my concerns and seemed to think I would be fine. I think I tend to bleed quite a bit during birth as I lost about 400ml with DD, although I only had a graze and didn't need any stitches. Much nicer experience all round

betsyboop That sounds quite scary!! And makes my PPH's seem small. Thanks for the links I will read them a bit later.
I am under consultant care, although I must admit I was under the consultant last time, and thought they were rubbish! I am planning to be a lot more prepared this time, and am thanking god that in my last pregnancy my one blessing was a fantastic midwife!!
From what you've said regarding big babies, the fact I have had 9lb6oz, 10lb10oz and 9lb13.5oz babies, it could be possible that my uterus is a bit knackered for want of a better word? Also interested to know if they said to you a further baby would be too risky?

noahandthewhale Did they think your PPH was mainly due to the tear rather than anything else?

Thansk everyone for all the info so far, it is really helping

I don't know why the PPH happened - I did wonder more at the time and then when pregnant with DD but I wonder if it had anything to do with the pre-eclampsia I had with DS had anything to do with it.

But as I still lost 400ml with DD I think I just do bleed.

Hope all goes well for you

Thanks for your help, much appreciated

I have had PPHs with all my three children. With ds1 I had a primary and secondary PPH, resulting in 4 units of blood a couple of days after his birth.

With ds2 and dd1, I just had primary PPHs (approx 1000ml with both). I didn't need any blood transfusions, only the delights of more iron tablets.

As soon as ds2 and dd1 were born, I was started on a drip to try to prevent/reduce the PPH. The drip didnt work well after my daughter, so had about injections in fifteen minute intervals (I think!)Also had the James Herriot style removal of clots (lovely)I was also kept on the labour ward for 24 hrs after the births, as it was closer to the theatres.

The midwives seemed to work on the basis that it was to be expected and so started treatment straightaway, ultimately reducing the bleeding.

My babies have all been large-ish too (8lb 6 to 9lb 14). The explanation I was given was the same as that given by BetsyBoop.

I prepared myself by fully expecting to have PPHs. I made sure I took my iron tablets religiously, even though I hated them, and hoped for the best! I was never offered the option of a CS and, to be honest, think the recovery of a CS would be worse than a PPH.
Good luck with whatever you decide to do.

I had a PPH of 7000mls but this was due to infection. Superb obstetric team avoided hysterectomy
If I were you I would avoid caesarian section if you can - it will increase your risk of significant PPH and you will tend to bleed more anyway. Sterilisation at the time of section is also slightly less effective than sterilisation later. Overall, it is also worth bearing in mind that female sterilisation has a much higher failure rate than male sterilisation or some long acting contraceptives like mirena coil.
I would talk to consultant about best option for avoiding PPH this time - can always request to see him or her sooner if this is worrying you. It may not be possible to stop it happening, but may help if you know exactly what will be done and how it will be managed.
Good luck!

I would definitely say after multiple pregancies with bigger babies you are at greater risk of "atony" (failure of uterus to clamp down after delivery), so yes your uterus might be "a bit knackered"

I was asked if I was planning any more babies and my answer was no definitely not, so they went no further (was 41 when DS was born, being over 40 is another risk factor...)

I don't think there is any way of preventing a PPH, it's all about managing it to minimise the blood loss. For example they might want to site cannulas and have blood cross matched "just in case" - also have an experienced team on standby.

I must admit when I think back (at the time I was hazy on morphine post c/s, which was probably a good thing ) once the initial m/w put out the "PPH" call, the team were fantastic. At one point there were 3 midwives, a registrar, a consultant and an anaesthetist in the room all busy doing "things", but they were totally calm, which kept me calm. They work to a protocol, if step 1 doesn't work move to step 2 etc., so it might be worth asking the consultant to go through this with you so you know what to expect at each stage.

Fingers crossed you won't get one this time though

Actually, I think I would have preferred not knowing the PPH protocol - I had just finished my job on labour ward to go off on mat leave so knew it backwards and was really scary to know that the next step was hysterectomy. Sometimes too much knowledge can be a bad thing. Depends what sort of person you are though and if it would help you, am sure consultant would talk you through it.

Odds are though that, although you may end up with a PPH it isn't going to be a massive one and hopefully no worse than before. Forewarned is forearmed for the obstetric team too - and PPH management is something obstetric teams routinely practice.

Fingers crossed for you!

Ah but I'm a "detail" person, so knowing the protocol would have helped me, but you are right smileyhappymum not everyone is as sad as like me

Thank you so much ladies for sharing your experiences, I really appreciate it.

I am going to discuss this with my midwife on Monday, as I think its causing me un-necessary worry/stress which can't be helping the baby or me in anyway. I'm feeling very anxious, worrying something will go wrong at any minute (have suffered previous mmc), and the worry of labour is making it 10x worse! So much so I think it's making me ill.

I had 2 PPH's...cant remember exact numbers now...but into the 1000's so with 3rd and 4th babies i had the drip for an hour after giving birth to help shrink my uterus down. Still heavier than normal bleeding but no big whopping clots!

I then went on to have two multiple births...both c-sections and had no 'extra' bleeding....however i had to sign forms allowing for hysterectomies if they were needed due to my bleeding..that was never needed..i thought at the time that happened for all c-sections though?? maybe it was for PPH risk then???

No, all C section consent forms include risk of hysterectomy - even though it is a tiny, tiny risk it's considered so important (for obvious reasons) that everyone should be aware of it.

Doodle, sounds like good plan to discuss with MW and at least get more info, especially if you are worrying. Then hopefully you can come up with a plan - always helps me cope with things I'm worrying about.

Take care of yourself.