Pulmonary Embolism in early pregnancy and wanting a homebirth.

[MrsRigby]

Has anyone had a PE and had a homebirth?

Are there any doctors or midwifes who can advise and aren't going to tell me I'm going to die in childbirth (as they did at my antenatal appointment).

Getting absolutely no support as I have no friends or family and after what the haematologist said DH is so scared that he's trying to bully me into a hospital birth.

Anyone?

hmmm, i haven't had experience, and i only know what i have just googled on PE.

but, what I would be asking is:

why are they concerned about the birth?

is there a reason why it would re-occur during labour?

what are the ACTUAL risks of whatever it is they're worried about happening?

if there are valid concerns for yours and your baby's safety you need to take it on board

you can still push for a HB, but you must make an informde choice and not just presume that you are being scaremongered to,a nd your DH is obviously concerned too

AFAIK< one of the risks is if you are on certain blood thinners, is taht you can bleed out

hvae you discussed this with a consultant/consultant midwife or only the haematologist?

a PE is really serious though

I assume you are on blood thinners?

No-one should bully you but you must understand that there are valid concerns for your health and your baby's health when you give birth. You need to make an informed choice and I would be amazed if once you have all the information you still want a home birth.

Please try and see your dh's point of view - I'm sure his main concern is your health and the health of his baby.

thisisyesterday They're concerned about the possibility of me having a haemorrhage.

Apparently, the first 6 weeks after giving birth are when I've got the highest chance of having another PE or haemorrhage.

No idea of the actual risks. They pretty much just bullied me. Told me I was having a hospital birth, told me I'd be in a consultant led unit and didn't say anything else.

lulumaam yes I'm on Fragmin and severe bleeding is a concern. Things weren't discussed. I was told I was having a hospital birth in a consultant unit and if I didn't I would die. There was no discussion.

Thank you both of you for your speedy response. Done some Googleing myself, but can't find out anything more than I already know.

hmmm so i would be asking to speak to the consultant and asking what percentage of people with a previous PE haemorrhage during childbirth and then perhaps making a decision based on that?

also, if you heamorrhage then what exactly happens? i mean, what do they do? is it conceivable that a midwife could cope with it until an ambulance came to get you to hospital or would it be so bad that you really would need to be in theatre asap?

Wow, another post. Thanks belgo.

Yes, I'm on Fragmin 7,500 bd.

I can see everyones point of view, but I had a very traumatic time in hospital last time. They wouldn't let me breastfeed, took my son off me and had someone feed him formula. They kept us in hospital for 3 days after a uncomplicated pregnancy and epidural. They preformed uneccessary tests on the baby. The midwifes looked at me with discust and I felt I was a criminal. On finally being released from jail/hospital I had midwifes telling me I wasn't feeding my son, even though he was never off my breast, they weren't supportive of breastfeeding and bullied me into giving him formula after a month. I then suffered 7 months of postnatal depression. I never had this rush of love that your supposed to get and I'm still having trouble trying to bond with him now.

Telling you what's what isn't bullying. The day after my previa scan the consultant sat me down and said "You are having a caesarean". I don't think that's bullying.

thisisyesterday I don't know. Personally I can't see why, if there is a problem, the ambulance can't be called and I'm transferred to hospital within 15 minutes.

Thanks toldyouso.

Now I am about as pro homebirth as you can get - but bleeding out is a genuine risk here and i think what you need to do is take your concerns about your previous birth to the hospital and ask them to help you devise a birth plan that would protect you from this happeneing again - if it is in your notes to not formula feed for instance - they cannot go against your will so have it made concrete and remind them of it when you go in.

PE, as you know is incredibly serious, bleeding out is something that happens really quite quickly and at home it is not possible to transfuse you and you would have to wait to be transferred in.

Like i said, i am very very pro homebirth, i have had 2 myself and planning ny third right now but honestly, in your situation i would not even entertain it for a minute. Please please have a rethink and also take your h's opinion into account - he is saying this because he loves you and careful negotiation of your birth i think is the answer.

I'm sorry you've had a bad time.

And I'm not convinced about the "rush of love". I think we all tend to feel similar things, but identify them differently.

For example: I once read a post somewhere on the internet about how this lady was having out-of-body experiences with her baby, she said it was like she was inside his skin, a part of him.
Wow, intense stuff, I thought. Then I realised I'd been doing the same thing, but I called it impersonating him!

It's all about perception. Try not to dwell on things like that and think about your health and that of your baby.

Sorry, rambled a bit!

i think it depends on what action needs to be taken?

i mean if you did start to bleed, is it conceivable that the midwife/ambulance crew could hold everything together for the 15 min transfer? or would it be more serious than that?

i'd want statistics though tbh. if they said to me that 20% of people who'd had a PE went on to heamorrhage during childbirth then i wouldn't take the risk
if it was 1% then i might!

Your DH is presumably terrified for the safety of you and the baby so calling his actions "bullying" is not very fair. All he probably wants is for his family members to stay alive.

As for the medical staff, they are telling you to go in the consultant led unit for the birth so that they can sort you out if things go wrong.

It seems that your problem with hospital is the postnatal ward. I am not surprised, your experience is typical and these places are horrendous. At least you know this time how to prepare for this part of it. For me, the second time, I was prepared for the shitty treatment. Remember that this time you are far more able to know what your baby needs and you are well prepared for them trying to feed the baby formula. You should insist that your baby is never removed from your sight unless there is a medical emergency with either of you.

In your position, I would opt for a hospital birth and I make your criticisms of the postnatal ward to the hospital via the consultant who is currently responsible for you. But this time, you will be prepared, it makes a lot of difference.

also, you realise that you can go to whichever hospital you like don't you?

you don't have to go to the same one you had your son in

why not have a look around and find out about other options, there may be more "baby friendly" hospitals around.

MrsRigby - this is my opinion: you need to find out exactly the medication you will be on at the end of your pregnancy, when you are due to go into labour.

You need to ask: are you likely to bleed, if so, how heavily, what can be done to prevent and stop it, and is a 15 minute transfer to hospital safe if you are bleeding heavily or uncontrollable.

Ask them exactly what they will do in hospital to make your birth safe and ask if this can be done at a home birth.

I bled after my last home birth and it was very scary - fortunately the midwives coped with it very well but it still took me months to recover. I had no clotting problems during pregnancy, was on no medication and was considered very low risk. But still I bled too much and the feeling of the blood gushing out of me stays with me still in my head. For this reason I would not have another home birth.

I'm sorry to hear about your traumatic first birth. Have you considered speaking to the doctors/midwives and trying to make them understand how traumatic your birth and the aftermath was? Would you consider hiring a doula to support and represent you during the birth? Do you have the names and numbers of breastfeeding experts whom you can talk to before the birth?

This exact thing happened to a cousin of mine about 8yrs ago. She bled out after delivery and was rushed to surgery. She needed goodness knows how many pints of blood followed by almost a week in intensive care to get her recovered.

She has never had another child since.

i have been on blood thinners during both my pregnancies due to DVT

with my first, I bled quite a lot and wouldn't stop bleeding when they were trying to stitch me - they were minutes away from taking me to theatre and they managed to control it

with my second, i had a water birth but in a hospital - blood loss ok and no tears

DH was utterly opposed to me having a home birth because of the risks and i had to respect that

it is a danger of bleeding out - but it doesn't mean you can't have a good birth in a hospital IME

Thanks everyone. I'm going to write down all the questions you've told me to ask and I'm going to tell them about the hospital birth last time.

Appointment next Thursday.

great post belgo

it sounds a lot like, with some proper support and better midwifery care, you would have a far more positive experience in hospital

i am v v pro home birth , BUT with something serious and potentially lfie threatening you have to consdier hte pros and cons

you need a proper discussion with your caregivers nad if you are being todl what to do , rather than given the info to make an informed deiciosn, you can change doctrs

the consltant midwife is worht speaking to and the supervisor of midwives if your MWs are not being spportive. i would also raise the concernes about your post natal care and your breastfeeding issues and ensure that you are very clear about how you will be treated this time

re the previa and c.s that someone mentioned lower down, with a previa, esp the two most serious sorts, where teh placenta is touching or covering the internal os, a c.section is the only option that is available

I'm sorry to read about your previous birth and care, it must have been so upsetting and traumatic....

The obstetric and midwifery team are rightly concerned about the real risk of a PPH. The causes of pph are subdivided into 4 distinct main causes (but there are others).
Tone - the uterus not contracting properly following delivery, can be associated with prolonged labours, multiple pregnancies, big babies, IOL, instrumental and CS deliveries and if you have had more than 5 previous babies. That said most women with those risk factors are fine. The treatment of a PPH associated with an atonic uterus can be begun (or completed depending how serious) at home with the use of oxytocic drugs, massage, breastfeeding, emptying your bladder etc.
Tissue - a retained placenta (or cotyledon or membrane) The bleeding could be minimised at home but it would ultimately mean transfer to hospital for an ERPC.
Trauma - a tear to the vagina or cervix, most of which can be repaired at home, with the exception of 3rd degree or cervical/ high vaginal.
Thrombin - your body can not clot your blood to stop bleeding, this may be caused because you have already bleed a lot and lost all the natural clotting factors, have a hereditary clotting problem or because you are on antenatal thrombophylaxis.

The midwives would be unable to manage bleeding caused by a clotting problem at home as the usual treatment for the most common causes are ineffective and bleeding can be heavy and life threatening in a very short time. The treatment would be to give an antedote to the fragmin or clotting factors. Most obstetricians would consider IOL at term, the rationale being that you can stop your treatment 24hrs before and minimise the risk of bleeding whilst also shortening the length of time with your thrombophylaxis. They would also perform blood tests prior to labour to check your clotting times. If you were to await spontaneous labour there is the chance that you could have just taken your fragmin.
Each case is individual, talk to your consultant and haematologist, nobody wants to scare or pressure you.........Remember they have to give the worst case scenario so you can make an informed choice.
I hope that you reach a conclusion you are happy and feel comfortable with. Best wishes.

Whoops, I meant limit the amount of time without your thrombophylaxis...
Ps have a look at the Royal College of Obstetricians (RCOG) website for the most current research based guidelines.

I have been in the same position as you I had a dvt in early pregnancy and was kept on fragmin till 6 weeks post partum

when you are on a treatment dose of fragmin ( which you are because you have acrtually had a dvt in this pregnancy) they have to carefully take down your clotting levels before the birth and carefully put them back up again after, ( they did this with a drip for me)
The risks of pph are high and you do need to be in hospital to give birth.
This all said I had a natural delivery ( was also my second baby) and the labour was much easier once it got going, they did have to induce me but I felt much more in control and knew what I was doing more. As a result I felt able to tell my caregivers what was happening and they listened to me.
I was able to breast feed my second baby but not my first so in many ways it was more successful delivery despite being very medical.
It is really much safer to give birth in hospital when you are on fragmin and it is best to take the doctors advice.