If you have a PPH are you more likely to have one again?

[KHR1]

As it says really! I had a PPH after my DC1 was born and now that I'm getting into my third trimester with DC2 I've started to worry about labour and birth again. Will having a PPH make me more likely to have one again? Have people had one for one birth but not in subsequent ones?
Thanks in advance!

Hi OP, I also had one with my first DC and I'm second trimester with baby 2. Is this something you've discussed with your midwife?
I was actually put under consultant led care for this pregnancy due to previous PPH. I was told it could happen again but that they would take measures to be more prepared to deal with it.
I would discuss as priority at your next appointment.

Thanks. The only time it's been mentioned is at my first consultant appointment as one of several reasons I was under their care, but I didn't think much of it at the time as I knew I would be under their care for other reasons and they just listed it so never explained. I'll definitely be asking about it at my next appointment though, never really crossed my mind until now

I gave birth to my first child in March. I ended up having an episiotomy, vontouse delivery and a PPH. The consultant came to see me the next day and assured me that these things are common in your first birth and doesn't mean I'm at higher risk of it happening again and I would be under midwife led care if I have another child. Not sure how true this is but I would definitely ask your midwife at your next appointment as they do tend to be very knowledgeable.

Hi OP, I’ve had 4 DC. Although my first wasn’t classed as a pph, because I did seem to eventually stop bleeding without drug intervention, I lost enough to require a blood transfusion. Then with my second, I had a huge pph and it took extreme measures to bring it under control. I was then consultant led for my third and it was far less stressful. This time they had a syntocinon drip ready to be switched as soon as I delivered so that my uterus was forced to continue contracting. I did start to bleed out after my DS was born but it was quickly controlled and I was well afterwards. When it came to having my 4th DS, i was consultant led again and the plan was to have the syntocinon drip ready to go again. However, for some reason, despite me asking them to connect it to me several times, they didn’t and so when I delivered my DS, I did indeed go on to have quite a large pph before they brought it under control.
What I would advise after all of those experiences is to ensure you are connected to a syntocinon drip during active labour and that they switch it on or are immediately prepared to switch it on as soon as you deliver just in case.
That said, I honestly don’t know how common I was to be so unlucky with my births and it may depend on what they determined as the reason for your original pph as to what course of action they suggest for your second.
I would also advise trying not to worry about it too much, it’s not a certitude that you will have another one and if you do they should be prepared. Good luck and best wishes.

Thanks @WhiteHorse92, that's reassuring!

@Lostinacloud that's interesting about the drip being used to control the bleed. I was on the drip during active labour as I was induced but im sure it was turned off before the pph. I'm not sure on what caused it but it's something I'll ask as I'm assuming it'll be in my old notes somewhere

I also had a PPH after DC1, due to retained placenta. I was told while pregnant with DC2 that once you've had a PPH, you are at increased risk in subsequent pregnancies, but that the overall risk is still low.

I had no problems at all with DC2 - very straightforward water birth and 'normal' levels of blood loss. I was home 6 hours after the birth and did the nursery run two days later!

This is pure speculation as I have no medical background, but I always think the individual risk level must surely depend on the reason for the PPH first time round? In my case, I'm convinced the midwife botched the delivery of the placenta, which caused it to be retained - I think she rushed it. The second time couldn't have been more different - due to my history I had the most senior midwife on the ward for that stage, it was a much more controlled delivery and everything was fine.

@nomorebabiesnow glad your second birth went more smoothly! Yeah, it definitely makes sense that the cause of the pph will likely determine how likely it is to happen again - going to try and find out what it was l, something I probably should have asked before

@khr1 hopefully it will be the same for you too! I did a lot of reading around this when pregnant with DC2 and there were so many positive stories from women who had had a PPH first time round and gone on to have straightforward second births. I think the odds are very much in your favour, regardless of the cause. Even if the risk is slightly increased, it's not a done deal by any means. Good luck

Yes that’s true. Mine seemed to be caused by my uterus essentially just giving up after I’d delivered the baby so it stopped contracting when it was supposed to carry on after delivery of the placenta to close off all the placenta entry points. That’s why the put the drip on as I delivered, so that I kept contracting.

My SIL had a very very bad one after her second child and nearly died because of it something to do with her placenta too, she was under a consultant for baby number 3, had a very easy quick birth with no problems with heavy bleeding thank goodness the doctors really thought it would happen again but it didn't. Good luck z

@Lostinacloud the synto drip helps if uterine atony is what’s causing the bleed but may not if it’s due to something like a perineal tear so asking to having from the go may not make sense. Some places also no longer use it as there’s a long acting analogue that is given just as a bolus. Synto can cause quite significant side effects so it’s use does have to balanced with the risk of those compared to the cause/risk of ongoing bleeding.

@KHR1 the doses (and standard concentrations) of synto used to augment labour is different to the dose used post-delivery for a PPH so they wouldn’t just have carried it on when you started bleeding. HTH.

It depends on the reason, but if its something like placental abruption, then yes it is more likely

I had a PPH with my second which was a MMC at 15 weeks. Then had a PPH with both my 3rd and 4th term births. The 4th was more prepared with the medication ready in case.

My SIL had a PPH after her first, second and third pregnancies. Induced coma each time. Hysterectomy after the third because they couldn’t control the bleeding.

I had a PPH after DC1 but wasn't classified as that at the time as I bled slowly for a longer time. After 24 hours I was short of breath and put on a drip and iron tablets. When PG with DC2, I was put under consultant care, and reviewing my notes it seems I lost about 1.5 litres. I don't know how bad that is though 😳

It didn't happen again with DC2, and when I had DC3 I was put under midwife led care.

@EekThreek over 1000ml is classed as a major PPH, I lost 1.7litres. I was never put on a drip, they kept my canulas in just in case but never did it. I got iron tablets but it took over 24 hours to get them prescribed.

After looking online I'd guess that my PPH was caused by either my BMI, my episiotomy or being on aspirin (or a combination).

Thank you for clarifying @Greybeardy, that makes sense!

@DicklessWonder gosh that must have been incredibly scary

Thank you for all the replies so far it's really helpful to hear different stories

I had a severe pph after DC1, had a cord prolapse, emergency CS where I was knocked out. Lost so much blood I had several transfusions afterwards.
When I had DC2 it was another emcs due to fetal distress and had another PPH, I was offered a transfusion but I refused and was on iron tablets for 12 months, which brought my levels back up slowly.

I had a major PPH following DC1 (no known reason) but no problems with DC2. I was under consultant care, and at my appt with him he basically said that they would just make sure to have relevant meds close to hand if they needed. Thankfully they didn’t! Good luck - hope all goes well.

I had a a 2 litre pph with my first and needed iron tablets and blood transfusions. My uterus didn’t contract after a long labour so needed meds to help but thankfully not surgery. With my second child I was consultant led and had a cannula fitted for labour with bloods cross matched and on standby just in case and medicine on a drip to help things contract. I did still bleed a bit but it was much less and didn’t need transfusions etc. So yes, it can happen again but usually the medical team will be prepared for it and better able to respond if it happens.