Want to have DC2 in an MLU after haemorrhage last time?

[Gerdticker]

I had a retained placenta with PPH after my last (rather fast 5 hr) labour.

I had the baby in the water at an MLU (great birth!) but the cord snapped and I had to be transferred to hospital for manual removal in theatre. Unfortunately there was a huge delay due to a busy theatre, so I waited 5 hrs for the removal and had a 2.5 lite PPH in total while I waited. Then I had a blood transfusion.

I feel sad that maybe I wouldn’t have haemorrhaged nearly as badly If I hadn’t had to wait so long.

Anyway! Pregnant with DC2 now, and really really wanting to go back to the MLU as I had such a great experience there, and I don’t like hospitals after my awful experience!

Has anyone else had any experience of PPH, and managed to argue that they can have their next baby in the MLU? Or maybe a home birth?

Grateful for any advice or shared experience

(Also posted in the childbirth forum as hoping to find anyone who can help me!)

I tried to argue the case for a home birth or failing that a MLU but was outwitted by the medical professionals. In the event, they were right and I was wrong - it turned out to be another dodgy birth.

@goodbyestranger ok that’s interesting to hear thank you. Would you be able to share a little of the detail of what happened for you? Be v grateful if you can

I don’t want to be irresponsible so I really appreciate responses from both sides

Is there a hospital near you where the MLU is on hospital grounds? Our MLU is next door to the delivery suite so I think they are a little more lenient on risk because there aren't massive time delays in transferring to theatre

I wasn't accepted in a mlu after pph after previous birth.

mw took some extra measures to reduce risk of a repeat at the birth.

@Findahouse21 sadly in my area (brighton and sussex) the MLU is 25 min from the nearest hospital with an obstetric unit.

It’s a great MLU though, I love it there! The midwives age amazing and their statistics are incredible - hence my desire to go back!

And in my experience, it was the hospital that let me down, not the MLU. It’s a tricky one!

@pinkbalconyrailing ok thank you - do you know what extra measures the MW took specifically?

Sounds like it would be worth getting your notes reviewed in detail with whoever decides where you can deliver (? Maybe ask for an obstetrician appointment). Retained placenta is something that is more likely to happen if you have had it before - it would be important to try know whether the cord snapped because a midwife was just too “enthusiastic”, so perhaps not a true retained placenta, or whether actually your placenta was already retained and difficult and it snapped as a result of that. The first option is less likely to be a problem again.
Re the PPH volume - sounds right that the delay caused the extra bleeding - however sometimes a retained placenta can cause significant bleeding within the first wee while and certainly a 25minute transfer with a bad PPH could be life threatening.
Things that can be done to reduce chances of it happening again - “active management” so a medication to aid delivery of the placenta, given after delivery of the baby; then a little bit of patience and a skilled midwife helping deliver the placenta. Gravity often helps - sometimes women deliver the placenta more easily upright, eg over the toilet (with a pan to catch it!). And for you - caution with the pulling on the cord part and trying to let it deliver itself in a way.
Shame it’s not an alongside MLU because I think that would be perfect for you!

I have had 5 natural births. Second I had a minor PPH which they managed to stop without too much anxiety. This worried me a bit for my third delivery (6 years later) so I chose to be in hospital. Correct decision as this one was much worse, I passed out as the room filled with people pulling clots from my uterus which was as horrific as it sounds. I didn’t need theatre as they managed to stop the bleeding.
I was understandably anxious for birth number 4 (another 6 years later) but it was uneventful in this regard, as was number 5!
So, basically, you never know! Personally, there’s no way I’d have risked being anywhere but a hospital. When things went wrong I knew I was in the best possible place and that was hugely reassuring. It’s just not worth the risk imo.

I had a horrific PPH and 3ended up in intensive care. One of those stories where Im glad I laboured onsite (I had planned a homebirth)

I wouldn't want to be 25mins away if a pph like mine is a possibility to be honest.

Id work with the midwife to take elements you liked into hospital and feel a sense of control (ball/music etc...)

I really feel for you OP. I would (and did) want my second birth in the MLU as well.

I had retained placenta after my first birth. I suspect it was caused by my incredibly full bladder. I had a 2 litre PPH and narrowly avoided a blood transfusion. I had a crash team rush me from MLU and some bloke pulling clots out of my uterus while they tried to stabilise the bleeding. I didn't love it and DH was terrified.

Second birth and I wanted a home birth. They couldn't stop me from doing this if I wished, but I was heavily discouraged by the consultant and DH. Out of respect for DH I didn't push it. But I was determined I wanted a pool birth in MLU.

The consultant refused to sign me off for an MLU birth but couldn't seem to explain why, when the MLU is right next to the hospital in my area. It's a 20 second walk. To me, there was no increased risk arising from my decision. I thought she was being irrational.

The risk of a second PPH is higher for those with history of PPH, but still only around 18%, as compared to 6% for a birth with no history of PPH. I felt that the odds were in my favour when the cause of my PPH was likely to have been my full bladder and I could ensure I didn't have a full bladder this time around.

I went to see the head of the birthing centre who was fabulous. She wrote down my wishes and asked me to sign to confirm I understood the risks, then agreed to overrule the consultant and take me in the birthing centre. Her focus on my wishes above all the other noise was incredible. She did, however, make it clear that I would need to agree to immediate transfer at the first sign of trouble and a managed third stage. I was completely happy with this compromise.

I went into labour at 6:45 on a Sunday morning. I had a peaceful labour in an empty MLU and had DS at 1:30pm in the pool. I was injected with syntometrine and the placenta came away easily. I was home by 7:30pm. The very best bit was that the wonderful head of the birthing centre was on shift that day and delivered DS.

I can completely understand your wish to have your baby in the MLU. You may find that the MLU is unwilling to take you if the transfer time is 25 minutes, but it is worth asking them. I don't know if I'd have been brave enough, ultimately, to have DS in the MLU if it wasn't annexed to the hospital, but this was only because the consultant had done such a comprehensive job of scaring me.

Perhaps it is worth considering whether you can elect to have your baby in another hospital which has an MLU on site?

@Stringervest Thanks so much for this.

Sadly we don’t actually have an MLU in Brighton & Sussex. Just 2 hospitals, Brighton & Haywards Heath. It’s a real shame. The MLU i went to last time is in my neighbouring trust, but about 8 miles away from their hospital.

So I think as @PineappleUpsideDownCake has suggested, my best bet is to make the Hospital birth as good as I can get, and take my own music etc. It’s such a shame that due to Covid I can’t go and look at the maternity ward before the day

Thank you @TenThousandSpoons0 too - I think we need to campaign for an MLU in my area!