Increased risk of PPH? - Post Partum Haemorrhage

[bobbles]

Hi Ladies (and gents if we have any lurking in this part of the forum)

I am currently 28 weeks pg with baby no2, and got my consultant's backing for a homebirth yesterday....(she's a lovely, nice pro-homebirth consultant, if there is such a thing!).

The only thing she kind of questioned , was whether the combination of me being very overweight my HMS would make me more at risk of having a PPH (Post-partum haemorrhage), as this had been raised by anaesthetist when I saw her a few weeks ago.

I said I thought that kind of thing applied more to people with vascular types of the condition, not me with my dodgy joints and probs with local anaesthesia.....but I'm not really certain?

Does anyone know if we are increased risk for PPH, and if so whether this would be a huge increase or just minimal?

Sharon xx

[tireesix]

DD2 (who I also home birthed with) I was overweight and I did suffer a PPH.

HOWEVER, despite the MWs knowing the pootential risks this time round they are still comfortable with my home birthing because it can be dealt with at home. I don't think its huge increase but its still something to be aware of.

I didn't have a PPH with DD1 due to having a managed third stage so if it is something you are concerned about, you could always opt for that or you can try the wait and see approach.

[bobbles]

I had already thought about accepting the oxytocic for the 3rd stage as a precautionary measure, I ended up having it last time as my planned homebirth ended up being a hospital birth, things wentit pear-shaped in 2nd stage, and I was at a point of being a bit scared of anything else going wrong, so I scrapped the physiological 3rd stage, and took the jab of Syntometrine.

I'm not hung up on having a physiological 3rd stage this time around - it's more important to me to be in my own surroundings more than anything else.

My concerns though are about more seriou PPHs, that don't respond to the oxytocic drugs...as this is what the anaesthetist was getting at.

Sharon xx

[tireesix]

From what I can gather, PPHs that don't respond to the drugs are fairly rare (from otther people I have heard it quoted as maybe 5% or less).

From what I can gather, those with HMS do have an increased risk of PPH but there is still a question mark over it. If there is a question mark over it, I am going to assume its a minimal risk. Being overweight increases the risk of a PPH, apparently, that one seems more definitive....

However,

It would seem that having a homebirth can decrease the risk of a PPH so maybe it all becomes balanced in the end.

I was worried about having another homebirth considering previous PPH (which was only 600mls + but I felt like dog do do), BUT, I know I responded ok last time to drugs, the risk of it being serious enough to warrant further treatment isn't that high AND the MWs should be well versed in treating such emergency situations and also have the bits and pieces available to them in order to do it.

http://www.homebirth.org.uk/pph.htm
http://www.who.int/reproductive-health/impac/Symptoms/Vaginal_bleeding_after_S25_S34.html

[janey]

Hi Bobbles, regarding PPH, in this country it is diagnosed as a blood loss of 500mls or over however in other countries a PPH is blood loss of over a 1000mls.
If you are concerned about this ask your midwife to go through what she would do in the event of a heavy bleed, you can sit down together and write down a plan of care for this scenario. Hopefully this will make you feel more at ease for your homebirth. Wherever you give birth the actions are the same to prevent further blood loss, it is only if bleeding continues then help is called for, in hospital the midwife would buzz for a doctor, at home the midwife would call for an ambulance.
As a midwife, working predominantly in the community, I have never had to transfer a woman in with uncontrolled bleeding but I have had to deal with a few PPH's at home births and they have all responded really well to oxytocic drugs. After the birth it is always good to be aware of diet, lots of iron and vitamin c will help your body to quickly replace any iron lost but don't forget also, that women have a greater circulating blood volume during pregnancy and therefore can 'afford' to lose more blood without it being detrimental to health.
Hope that makes sense and hope you have a lovely birth.

[MandyG]

hiya - hope it's ok to add to this thread

I have HMS and have had 3 babies

1st - awful traumatic birth , missed brow position which was only found after 3 hours of pushing and 3 failed ventouse attempts - emergency section where I felt whole thing and was knocked out.

I apparaqntly had about 10 injections to stop the bleeding - lost 4000mls

really ill after and was in for one week

2nd successful VBAC which was fantastic, however I had a retained placenta and could feel myself drifting away, awful, had it manually removed with no pain relief which was torture - lost 2000mls. needed transfusion but felt fine

3rd elective section cause I wasn't going into labor myself. they were all aware of previous section and made sure I was given lots of spinal and I didn't feel a thing, lost 800 mls, felt blooming awful but they wouldn't give me a transfusion. I very nearly passed out on day 2 as I couldn't focus and almost collapsed - the care I got was awful but that's another story lol

anyway - I have always suffered heavy periods too and have been on 2 types of pills every month since I was 15 as I almost died from it. I was always sure this was connected to my PPH and this was before I knew I had HMS.

also all 3 of my babies were stuck in some way or other - first brow, 2nd and 3rd were back on back and stuck. was told I had a mis shaped pelvis and to get it checked - did any professionals want to investigate? no

I have no idea if all this is connected but I am gonna say it is.

xx

[emmajordan]

I had a mild PPH after my second birth, a little boy. 800 mils. I didn't want to have a transfusion unless it was very serious as I give blood and wouldn't be able to if I did receive a transfusion. I was fine as my Iron levels were perfect any hows. I did feel weak for a while. I would advise eating an iron rich diet and taking good pregnancy vitamins (not pregnacare) the Natural health practise were good.

If you do have a mild PPH you should be OK and if you have a big one then they will give you a transfusion,

HTH

Ems

[norfolkandchance]

Argh - why aren't there any answers?

I'm currently in the process of trying to find out how much risk I am at of another PPH. (Thanks for your messages Jane).

I had a lovely homebirth last time and want another but the home birth was complicated by a massive pph (3000ml conservative estimate). The midwives are not at all happy about me wanting a home birth and think it's far too risky - they're all happy to blame the HMS and have told me I WILL have another pph - it's just a case of how much.

Why isn't there any info out there? Do I just have to accept that I probably will bleed again? I responded to the emergency treatment and my haemoglobin never dropped below 11 which everyone is amazed by. (I passed out and needed to be rescusitated by the paramedics).

I'm so fed up and am feeling sorry for myself. The kids are really playing up as well. Argh.

Debbie x