Post Partum Haemorrhage - will it happen again?

[SamboM]

I have a dd aged 7 months, when she was born I had to have an emergency caesarean due to a failed induction (prostin for 5 days, then artificial rupture of membranes and Synotosinen (sp) drip for 12 hours).

Delivery was fine but I had a massive PPH, had to have a 10 litre blood transfusion and was under general anaesthetic for 9 hours and woke up in intensive care. It took me a long time to recover and my Dh had post traumatic stress I'm sure. He said it was the worst day of his life.

So, inevitably we are now thinking about having another baby (weirdos I know) and I was wondering if anyone else has had this experience and whether it repeated itself. I'm not sure I can go through that again and more to the point I don't want to put my Dh through it again. And of course I am thinking that maybe this time they won't be able to stop the bleeding and Dh will be left with 2 small children to look after and
no wife. And more to the point I'll be dead!!

Any advice gratefully received.

I had a PPH after dd1 was born but not as massive as yours. I fell pregnant with dd2 accidentally and, like you, was concerned as to whether this would happen again. Unfortunately I didn't get any real answers as to whether it was likely tor or not. Anyway, when I had dd2, labour was completely different - much shorter, less painful (epidural!) and no PPH. I have since then gone on to have a ds and again no PPH. So, it doesn't always repeat itself but I don't know whether it's more likely to or not. Like I said I didn't get any real answers to this question.

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SamboM - so sorry to hear of your experience. PPH is a complication of caesarean section but the amount you lost was obviously excessive. It sounds as though there were complications with the surgery. The section was obviously a knock-on from the failed induction. Why were you being induced? Would you hope to labour next time? If so it would be best to labour spontaneously. I have seen women deliver with no complications following a previous haemorrhage after delivery. Did you have a discussion with your consultant at your 6 week check to find out why you haemorrhaged so badly? There are lots of questions that need answered from your delivery to know if your risk of haemorrhage is increased.

They seemed to think that it was because of the failed induction. Apparantly when the placenta comes away there are lots of exposed blood vessels and the womb usually contracts back down and covers these, stemming the flow of blood. My womb was "floppy" and would not deflate, so they had to go in and stitch it back in. But that can happen in a normal delivery too and when you have not been induced, so I'm not convinced by that arguement.

I remember when I was 5 I had my tonsils out and they bled into my stomach without me knowing and I spent an hour vomiting blood in the shower. I wonder if I am just not suited to surgery.

SamboM - your failed induction would have contributed to your haemorrhage. Because you had been on a drip for 12 hours and not progressing the uterus was not responding. Induction can fail because the body is not ready to go into labour. At caesarean section the uterus became 'atonic', which means that it would not contract at all. As you have said, there is a big bleeding area when the afterbirth is removed and the uterus needs to contract to close the bleeding blood vessels off, which is what normally happens after delivery. Drugs are given to make the uterus contract but they do not always work. Any major bleeding vessels then need to be stitched.
Induction of labour is not the simple process that many women widely believe. The risks of induction are often not explained at the time the decision is made. There are times when induction is necessary but I see many women being induced for no good reason. Often it is because they are 'fed up' - that is the reason in the notes. Often it is because the consultant recommends it, but we have a consultant who likes to induce his women a week before it is actually necessary.
What happened to you is not typical regarding the haemorrhage but induction of labour increases your risk of a caesrean section.
Hopefully next time you will be able to go into labour naturally. Induction is definately best avoided with a previous C/S although it can be successful.
The body works best when left to it's own devices.

oh SamboM - you poor thing. Sounds horrific.

I had a PPH but very different story - it came 5.5 weeks after dd so I ended up back in hospital and got an awful shock. They reckon it was caused by infection and so I would HOPE it won't happen next time. (I guess next time I won't budge from the house for 2 months just incase!!).

Sorry I can't help but I would say talk to whoever you can and get reassurance and if all is OK then go for it with #2. Possibly the fact that you had such a hard time with #1 will mean that they will keep a special eye on you next time..... good luck

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Thank you all for responding. Mears, are you medical? The reason they induced me was because I have a family history of placental insufficiency, my mother's first child died in utero and two of my cousins had problems where the placenta was disintigrating. I also had pregnancy induced hypertension which they were worried was turning to pre-eclampsia, and lastly (but probably the main reason) Dh is a medical negligence lawyer and they were trying toooo hard! Next time I'm going to make sure they don't know about that.

I am a midwife SamboM. By the sounds of things you did have indications for induction as far a pregnancy induced hypertension goes. Interesting about family history of placental insufficiency - was that identified as a problem in your own pregnancy? There are varying degrees of PIH as well. How many weeks were you out of interest?

I was 40 weeks when they started the induction, had been in hosp for a week with PIH which kept going up and down, but never got above 150/100 (I was 130/80 when I booked) and when it was that high it came down again quickly. I had no other symptoms of pre-eclampsia.

No, the placental insufficiency was not an issue for me but I was very worried about it and kept hassling them to scan me etc as I was convinced that it could happen suddenly as it did to my mum.

I had the added complication that I have Crohn's disease and it was getting steadily worse, I was having to up my prednisolone and I was also on azathioprine and I think they just decided that with all these factors they would not let me go much beyond term.

Like most people I thought that being induced meant that that was it and the baby would be here in a day or two (how uninformed can I be??). They gave me prostin for 3 days, then I got fed up and went home to let things happen naturally but when I went in for my bp check the next day it was right up so they kept me in and tried again for 3 days. Then I had dilated sufficiently for them to do an ARM, so I went for that and the drip, and the rest you know.

SamboM I'm sorry that this happened to you and can't offer any medical advice but I was struck by your story because you seem to have been left facing the prospect of another birth with so little information about this MAJOR thing which happened to you. I'm in the process of writing a book about second births and I'm hearing this kind of story again and again - it really makes me sad. don't suppose you'd be willing to fill in a quick questionnaire about first births and how they affect our feelings about second ones? Your story is sooo powerful, and I think there are thousands of women like you who have one terrifying experience and are left just wondering if it'll happen again. If you don't fancy doing this, no problem of COURSE (I'm not in the habit of badgering people, honest, but I WAS so affected by your story when I just stumbled across it!) Whatever happens, I hope you get (demand!) all the right info and are able to go into your next birth fearless and fully confident that your dh will NOT be bringing up children alone. all the best.

Of course I'll fill out your questionnaire. I believe you can get my email address from the site somewhere, do you know how to do it?