Would you opt for a C-section in this situation?

[Lunalovegod]

I'm just hoping to see what others would do in this situation. I'm a bit stuck on making a decision as I don't want a C-section, although it might be the right thing to do. It might help me make the right decision if enough people say they'd opt for a C-section, although I know it's ultimately my decision. Sorry if it's a bit long-winded.

I had my first child 7 years ago. I knew I'd lost a lot of blood, but that's all I was told at the time. It's only been during this pregnancy that I've found out how serious it was. I lost 1.2L, narrowly missing needing a blood transfusion. I've now been told the average amount lost is 250ml, which has scared me tbh. If I opt for a natural birth again, I'm not allowed in the 'normal' delivery room, I need to have extra doctors on hand just incase, and I need to go on a drip afterwards to help expel the placenta.

My mum wants me to have a C-section. It's something I really didn't want, but I've been getting more scared the closer I get to the birth now (I'm due 9th Feb), and I've been wondering myself if it's something I should do.

I had major surgery for something else earlier this year already and it's not something I wanted to do again, plus I'm scared of the risk of infection and the scar afterwards. But I'm equally, if not more, scared of losing that amount of blood again and possibly needing the blood transfusion.
Though there's always the possibility that I may not lose too much blood this time. I don't know what to do.

How would others feel in my situation? I appreciate any responses.

How did you feel after you had your 7yo? I’d do whatever I felt put me in the best place to parent my 7yo and a newborn afterwards. Congratulations on your pregnancy.

Obs anaesthetist. Totally your choice really, just because you had a haemorrhage before doesn't mean you will again, do you know the cause of it? Pph isn't that rare, and although 'high' it's not "THAT" high by obs standards. You can still bleed from a csection, officially its quoted at 500ml but its pretty common to be at least 600-800ml

If you want to birth normally there's no reason why it needs to be any more medicalised than other births. We would recommend u have a drip in your hand whilst labouring but otherwise can be treated as normal

Try to eat as much iron rich foods as possible so you go into it with a good starting point

But I certainly wouldn't push someone with a previous pph into a csection if that was the only reason it was being considered, tons have pphs, we are v well trained in managing them and previous doesn't guarantee it will reoccur. Equally csections are v safe if that'd give you more predictability

Initially, I wasn't okay, but I've always just assumed it was normal to feel like that after childbirth as I knew no different. I wasn't with it at all for hours, to the point I asked the nurses to take her for a while and watch her while I recovered. I honestly just thought that was normal. I went home the next day and I'm now horrified I was let go so soon to go home with a baby after that amount of blood loss, as I've read it can take weeks to recover from. I did develop severe anxiety from the off, and although I obviously can't blame the blood loss, I do wonder what kind of mind frame it would have left me in.

It may just be the turn of phrase you are using but 'not allowed' and 'need to' are quite alarming to read. You know you can do whatever you want, right?

Yeah that's true. Previous pphs we strongly advise not to have a pool birth, but if the woman wants it that's fine if she accepts the risks. Same as we wouldn't recommend a home birth but nothing will be enforced on u its just advice

Okay thank you, I am low on iron and have been given iron tablets so that's an added concern right now.

I don't know know the cause of it although I suspect it's because I was induced. Doctors haven't confirmed that, but it's my theory after reading that induction and the drip can cause blood clots.

That's all really helpful to know to go towards making my decision, thank you.

I wanted a water birth but I've been told I can't have one

This hasn't been made clear to me tbh, I've been told that's what has to happen. I don't seem to have been given another option.

I lost a very similar amount of blood in a PPH with my first OP, but it was in the course of an emergency c-section. I therefore wouldn’t opt for a c-section for that reason alone, just because I know a c-section doesn’t prevent a PPH from occurring.

That said, every person is different and there is no wrong choice, so if a c-section feels right to you then absolutely go for it. But it seems like you’re not sure it is what you want, and it’s not necessarily a solution to your concern.

I don't think anyone can tell you I'm afraid. I will say I had to give birth at 38 weeks so chose a planned c section, and I have no regrets. It was very calm, straight forward and I was never in pain. I was walking around the block day 4, and completely off painkillers by day 7. No infection. However, you don't necessarily know how it's going to go for you or how you'll feel afterwards, as I know some people have worse recoveries than me. I think you just need to think about what would make you least anxious. Happy to answer any questions you have.

The drip doesn't cause clots. It does make pph much more likely... it basically increases the strength of the contractions to expedite labour...for that reason a uterus that has been strongly contracting for a long period of time, can get "lazy" once baby comes out, so the uterus doesn't contract as tightly as it should, and the lack of "tone" causes excessive bleeding

depending on your level of anaemia it maybe worth asking your midwife if it warrants a predelivery iron infusion xx

Yes my labour was so intense and only lasted 2 hours. The clots I had were huge and I've always thought it was due to the intensity of the labour. I have mentioned this to the consultant and asked if I avoid induction this time could I potentially avoid the blood loss, but obviously no-one can say for sure.

They said my iron is only slightly below what it should be so it's not too bad, although I'd like it tested again before the birth and I will ask about an infusion (I didn't know a about that), thank you.

I’d meet with a midwife and ask for a debriefing session for the last birth, go over anything which might have contributed to the pph. Like a previous poster said having the drip in labour increases the risk.

ask what the plans would be for this time…..so probably a cannula and a planned higher dose syntocion drip to help your uterus clamp down.

you could ask to talk to a consultant midwife about a birth plan for this birth. So would going in the pool for first stage and coming out for pushing be a compromise you’d be happy with? Or would you want to stay in the pool for delivery? They will be twitched if you had another pph in the pool and collapsed and they couldn’t get you out and then couldn’t manage the situation very well.

I had a VBAC for my second and because of this was hooked up to the monitor and had a canula in. I avoided a drip but mainly because a lovely student midwife kept passinge a drink between every contraction. I thought it would be awful and would restrict me but actually it wasn’t and I had two midwives with me plus a student once I got to the pushing stage and felt really relaxed as I was being very well looked after. Unlike the first time round where I was pretty much ignored!

Did u deliver without forceps or instrumental last time? If so uve got a good chance of delivering without intervention or needing induction as 2nd time mums the body knows what it doing at 2nd go

Everyone gets their haemoglobin checked on arrival to labour ward (this is the number of red cells you have, not iron, as iron takes weeks to replenish and result in a higher number of red cells being produced. We can do iron infusions post op if significant loss but not enough to need blood.

I've had 3 c sections.
The first one I haemorrhaged and lost 1.9L and needed a blood transfusion, the second one I lost 900ml and the third one I lost 600ml.
Having a c section doesn't guarantee you won't have large blood loss and I'm not saying it's not the best option for you, but definitely have a debrief and look at all options and how/if things can be done differently this time to avoid a PPH where possible.
I personally haven't enjoyed any of my c sections, I've found them terrifying at the time and the recovery is ok, but harder with each one. That's just my personal experience though and as long as you are well informed you will make the decision that's right for you.

The drip isn't there to prevent dehydration, and no amount of drink administration would convince me to not want to cannulate someone with a history of haemorrhage

The drip is there to give emergency drugs in the instance of bleeding to reduce it, induce uterine contraction or give blood/fluid if significant bleeding.

When someone is bleeding heavily their veins constrict to divert blood to the heart and brain, meaning trying to insert a drip in this situation is significantly harder and a threat to life. Its nothing to do with dehydration

You don't need anything connected to it whilst laboring, the needle is immediately removed it's just a small plastic drip that stays in place

I wasn’t clear in my post. My canual was in incase of quick access for drugs and incase they needed to give fluids for dehydration. I didn’t haemorrhage first time. What I was trying to say was I wasn’t keen on a canula at all or being on a monitor but it didn’t interfere with my labour. Obviously the OPs risks are different to mine so her treatment will be different but she would still be having things she would rather not.

I lost just over 1.5 litres when having my baby via C section. I had been induced and had been on the hormone drip a long time (>12 hours) before agreeing to the C section and unfortunately this does increase the risk of PPH quite a bit which I think is due to the impact it can have on oxytocin receptors in the uterus.

Personally I hated the C section and would not opt for one on the basis of previous PPH alone. I would be wary of agreeing to an induction (with drip not just e.g. breaking waters) again in your position but obviously that will very much depend on how things progress in pregnancy/labour.

I would make sure you discuss with the consultant how exactly they are planning to manage the birth given your previous PPH so you're aware ahead of time. I would also make sure that you aim for (and state) your desire for immediate and uninterrupted (if possible) skin-to-skin with the baby after birth as I believe there is some research that this can reduce the risk of PPH. Taking away the baby for things like weighing right after birth is not necessary. This should be able to be accommodated in the vast majority of scenarios including after a C section if that is the route you choose.

Blood loss at a c section is generally more than a vaginal delivery. Up to 500ml is considered normal with a vaginal birth and up to 1 Litre with a c section. Have you talked to your care team in detail about this? They should have hopefully explained to you that a c section would not be in your best interests if the driving factor is avoiding blood loss. Your Mum wouldn't know this either I'm sure, so means well but probably isn't giving you the best advice.
Were there other factors at play that lead to your PPH first time? Things like induction, long labour, unusually fast labour, long pushing stage all make you more likely to haemorrhage and these things are less likely to happen with a second labour.
Once they know you've haemorrhaged in the past like you said they'll give the IV oxytocin and have other meds on standby and these are very effective at preventing excess blood loss.
All this to say - if haemorrhage is your only reason for considering c section then I would not do it personally, as it becomes more of a risk.

I had an emergency csection (although I wasn’t induced, my son had to come out very quickly). I lost 900ml which I didn’t think was that much. The surgeon said it was a standard amount. They didn’t give me anything afterwards.

Yeah no forceps or instruments were used! After a very intense labour, she practically slid out with 2 pushes! That is very good to know, thank you. Does this still stand with a gap of 7 years, as I've heard it's not the same if you've had with a big gap?

Thank you for your reply. I didn't actually realise so much blood could still be lost during a C-section, I thought it would be more controlled. I personally don't really want one so your reply really does help in going towards making my decision.

Nothing has been discussed in depth at all, my midwife was the first to mention it, then a meeting scheduled with the consultant lasted less than 5 minutes which just repeated what the midwife told me and felt like a complete waste of time. I do, however, have another meeting with the consultant booked, so I'll be sure to make this one much more detailed and ask more questions. I didn't realise, for example, that I could still request a water birth, with the option of getting out of the pool to deliver. My midwife told me I cannot have a water birth. There's a number of things this thread has brought insight to, so I feel a bit more prepared for what to say at my next meeting, and less inclined to want a C-section now that I have more knowledge (More so than what the consultant has provided me with so far!).

I had two c sections, one emergency and one elective, I lost similar amounts of blood to you, more in the elective actually. I felt absolutely fine, they were surprised at how ok I was after losing that much blood. No transfusions either time. Two of my friends had vaginal with interventions and neither lost huge amounts.
Every birth is different, there's no saying you'll lose that much blood again vaginally and there's no saying you won't lose similar in a c section so I wouldn't make your decision purely on wanting to avoid blood loss. I'd go with the advice of the midwife/consultant and whether you have any risk factors for this pregnancy. If you do go with a c section recovery is actually not that bad and an elective is a really nice, albeit surreal, experience at least for me!