After a PP Hemorrhage (sp) in a hospital would you consider homebirth?

[Ldavis24]

So 1st baby who is 6 months if that makes a difference was born at a hospital with a MW and literally no medical intervention (short of having a fetoscope used for her heartbeat) until immediately after she was born when I had a second degree nearly third degree tear and quite a large PP hemorrhage. It took about 20 minutes to get under control and my placenta didn't deliver they literally had to push it out to get the bleeding to stop, in addition to the pitocin and some other drug that they gave me that I don't even remember.

I had desperately wanted to have a homebirth but DH put his foot down and before DD was born I said that baby number 2 would be a homebirth! That was until the hemorrhage and he freaked out. I am not pregnant again yet but we are hopeful that in about a year I will be. I would love to have a homebirth still but after the first experience is it just too dangerous to consider it? I feel like I lost something I never even got a chance to have which sucks but I certainly wouldn't want to risky my future baby's health or my own. Would a MW even let me? Is it risky? I haven't read anything on the topic because mostly I come across personal experiences as opposed to actual science or numbers.

[marrymeflyfree]

Your story sounds similar to mine...first babe was born in a freestanding birth center with a CNM in attendance, had significant pp bleeding and similar placenta issues...IM and IV pit, IV and oral methergen to control it.

Second babe was born about 6 weeks ago. We planned to homebirth, but ended up transferring for unrelated issues (ascynclitic baby that just would not descend). Homebirth midwives aren't licensed in my state, so pharmaceuticals were a very limited option. It was a concern for me, and its something the MW and I discussed at length. I asked a lot of questions about how she manages it, at what point it becomes concerning for her, discussed how a transfer would be managed if it were necessary, etc. We also talked a lot about what likely caused it the first time and the chance it could happen again. And it was all for my comfort...she was not concerned about it and said there is no reason to assume it will happen again. Different baby, different birth, different placenta. Certainly it is something you should inquire about when interviewing midwives. I understand how it can be a stressful issue during the pregnancy...not knowing how it will play out. The more comfortable you are about how it will be managed if it should happen again, the better!

One thing my MW did suggest was ensuring my iron levels were strong prior to birth as the body will handle any blood loss better and compensate longer.

[~Kristina~]

I had a PPH with #3 at a hospital. #4 was born at home with a midwife with PPH experience. With her knowledge we avoided another one and she'll be delivering #5 at home very soon.

[nikirj]

I'd consult with MWs in your area; their access to meds and comfort levels are going to be different, so it's useful to actually talk to them. I'm not reading anything in your story that would risk you out of a home birth.

[hillymum]

I had major PPH with ds#1 but was in hospital already so I was just rushed into surgery for a manual removal of placenta and given a few units of blood.
DS#2 was delivered at home (in my bath tub!!!) and then I was transfered to hospital as again my placenta wasn't moving. There was no rush as at that point I wasn't excessively bleeding. Once the stupid, ignorant, never to touch a pregnant or new mom again in his life doctor got his hands on me it was a different story. Damn fool almost killed me!
Ds#3 was born in a birthing center with no complications. i delivered the placenta just fine with no excess bleeding at all.

For ds#3 I had 3D untrasounds to look for fibroids which were thought to be the cause of my retained placentas. None were visible.

[at_the_hip]

I had PPH with #2 and #3...#2 was in the hospital with a midwife, and #3 was a homebirth, handled with oxytocin shots. With #4 I took plenty of iron, and labor prep herbs in the last 6 weeks. They also had a hep lock for me to give me oxytocin right away after the birth. No excessive bleeding at all with #4 because of this, actually less than normal. I forgot just how easy recovery is when you don't bleed over a litre! But it is truly important to have a midwife who is comfortable with handling this and experienced in doing so - or I would not feel comfortable either.

[Ldavis24]

Thanks for all the replies! I find it so interesting how some bodies respond to labor and I know that part of my feeling like I got hit by a bus after birth was due to the blood loss. Nothing like the experience of actually feeling blood spurting out of your body to really make things interesting. I also had the pleasure of fainting on the toilet when I was finally allowed to get up and use the bathroom myself That is why the nurse insisted on going in with me

I don't know if anyone else experienced this but throughout my entire labor (over 40 hours) my contractions were never very strong according to my midwife. The closest they ever got was 3min apart and didn't last for more than a minute ever. The labor was so long by the end my midwife thinks my uterus was just utterly exhausted and didn't have the energy to push the placenta out. I was even nursing right away to try and help! At the pushing stage my contractions were still 5 minuets apart and we were all hanging out chatting and waiting for the next one. I have a sneaking suspicion that how my uterus acted had a role in how much I bled, it just wasn't contracting strong enough the entire time with nipple stimulation etc!.. I was about 20 minutes from getting pitocin to help things speed up (not something I was cool with) when my water finally broke and things marginally picked up.

The bottom line is DH is now terrified of a homebirth and constantly says you would have been one of the women who died in the old days! Isn't that nice. Unfortunately he is probably right but it doesn't help to hear it whenever I mention how I would love to have a homebirth for our second.

[mnnice]

I had both a hospital birth and a CPM attended homebirth and had issues with PP hemorrage in both cases (no issue with retained placenta either time). In both cases I was given pit intermuscualarly (which I hated). The CPM didn't risk me out for this reason (obviously) and told me afterward that if I had another birth I should just plan on getting the pit from the very start. I doubt she would have risked me out I had wanted another homebirth.

I am curious to if it would have been a concern with any future pregnancy I would have or if I was unlucky or somehow overintervened with in some not obvious to me way. (But not so curious as to have another baby just to find out )

Slightly OT--DH loved our midwife, totally understood why I wanted a homebirth, but never became completely comfortable with the idea of homebirth. My point is that if I had waited for 100% consensus on this topic I would still be waiting and my biological clock would have rendered it a moot point.

[paxye]

I had PPH after ds#2 after one of the MW's at the birthing centre pulled on the cord after his birth... if it wasn't for the intervention and managed third stage I am sure that it would not have happened...

I had a UC with my third without a problem...

[SuzyLee]

It would depend for me on whether your HB midwife carries pit and other anti-hemmorage drugs. Mine does, so I am not concerned about it. She can do the same thing they would do in the hosp unless it was so bad I needed surgery.

[sunfish21]

I had a pph at home--and am planning another home birth. My current midwife doesn't think that a previous issue indicates a greater likelyhood of it happening again (although I have heard others say differently). My labor was very fast and dd came flying out of me--I never pushed once--and I tore significantly. The midwife was on her way when she was born and so she wasn't there to see the blood loss at the birth. I had a large extra lobe on the placenta and a velemenous cord (sp) insertion...the placenta didn't come out for almost an hour after birth--it wasn't budging. I also fainted trying to go to the bathroom afterwards; being in bed for almost two weks barely able to sit up was awful! I hear you on that one!

We are planning on actually getting the midwife to use before this one is born in Feb (crossed fingers) and she promises warm ginger packs and perineal support--and pit if needed.

I know I can transfer if I need/want to, but I would never want to give birth in the hospital because of that possibility. I trust that we would get there in time if there was another problem with bleeding.

[ShwarmaQueen]

I had a retrained placenta and PPH with DS (lost well over a liter) but I think I'd still have a HB again. I had prepared as best as I could- took Floradix for the entire last trimester, drank RRT nettle and alfalfa infusions, put DS to the breast immediately, let the cord stop pulsating before cutting it, gave myself nipple stimulation by hand, and the MWs didn't pull on the cord or anything crazy. My uterus just stopped contracting (like not even a twinge) and the placenta wouldn't budge even with herbs and a shot of pit. I had to be transferred to the hospital and although it took about a week to recover from the bloodloss, I'd take this birth over a managed 3rd stage at a hospital.

[edensmomma]

Yes. I had a PP hem with my first child in the birthing center. We are planning a homebirth for this baby, due in 10 days. My MW just got my medical records and reviewed the reason why I hem. She has been monitoring my Hemoglobin closely, and has me eating lots of leafy greens such as Kale that are packed with Vitamin K. I also take WheatGrass Juice every day. It worked, because my hemoglobin was only 9.9 last week, started eating greens/wheatgrass juice and it jumped to 10.9 this week. Yay!

My hem was easily controlled with a shot of Pitocin, which my MW does carry also just in case.

[major_mama11]

Originally Posted by Ldavis24

Thanks for all the replies! I find it so interesting how some bodies respond to labor and I know that part of my feeling like I got hit by a bus after birth was due to the blood loss. Nothing like the experience of actually feeling blood spurting out of your body to really make things interesting. I also had the pleasure of fainting on the toilet when I was finally allowed to get up and use the bathroom myself That is why the nurse insisted on going in with me

I don't know if anyone else experienced this but throughout my entire labor (over 40 hours) my contractions were never very strong according to my midwife. The closest they ever got was 3min apart and didn't last for more than a minute ever. The labor was so long by the end my midwife thinks my uterus was just utterly exhausted and didn't have the energy to push the placenta out. I was even nursing right away to try and help! At the pushing stage my contractions were still 5 minuets apart and we were all hanging out chatting and waiting for the next one. I have a sneaking suspicion that how my uterus acted had a role in how much I bled, it just wasn't contracting strong enough the entire time with nipple stimulation etc!.. I was about 20 minutes from getting pitocin to help things speed up (not something I was cool with) when my water finally broke and things marginally picked up.

The bottom line is DH is now terrified of a homebirth and constantly says you would have been one of the women who died in the old days! Isn't that nice. Unfortunately he is probably right but it doesn't help to hear it whenever I mention how I would love to have a homebirth for our second.

The way you describe your labor sounds a lot like my experience with Baby #1. It was an intervention-free birth, but still I hemorrhaged. They managed it with IV fluids and Pitocin and manually removing the placenta. I went on to have a freestanding birth center birth with Baby #2 as well, with no PPH at all, despite my fears that it would recur.

I discussed it with my MW quite a bit during my 2nd pregnancy (diff midwife, same freestanding birth center), and she felt that the PPH was due to my uterus being tired out from the long, drawn out labor. We talked about being proactive: I ate a lot of leafy greens (for Vit K), drank RRL tea with nettles to build up my blood. THe one "intervention" that we agreed on using was stripping membranes, to try to get baby out before he got bigger than DD was (she thought maybe big baby + long labor = tired uterus for me).

I had in my birth plan that I wanted a saline lock "just in case" (was stuck for IV 7 times during my PPH with DD), but I ended up having a much faster labor 2nd time, much more efficient contractions, and didn't even think about asking for an IV.

I was amazed by how great I felt right after having DS. It's amazing how great it is to NOT have that "hit by a truck" feeling!

Oh, and one thing to consider is that most homebirth midwives do have with them what is needed to manage a PPH (IV equipment, Pitocin- these were all I needed with my PPH).

[jess152]

I hemorrhaged (sp?) in the hospital after having a c-section. I had two transfusions to get things back to 'normal'. I felt like death warmed over and was in the hospital 10 or 11 days, I can't remember which.

Flash forward two years and we are TTC again and I'm thinking 'how can I avoid the hospital and a repeat c-section?' I began thinking about homebirth with a midwife, but didn't know if I'd be high risk with a history of hemorrhage as well as an 'untried' pelvis and VBAC. My midwife didn't seem concerned, and with 35 years of experience, I trusted her. I did as much reading as I could on the subject.

I took my iron pills and she monitored my levels throughout my pregnancy. They were great. The morning after I had baby #2 she checked and they were fantastic, in spite of blood loss. It looked like a lot, but I have no idea what's normal.

My theory about the hemorrhage in the hospital is that I underwent a c-section without even going into labour. I think if I had, my placenta would likely have separated on its own, as opposed to the doctor pulling it out, possibly before it was ready. The whole hormone cocktail was completely interrupted, so any oxytocin that might have helped my uterus contract was bypassed.

It sounds like you have a while to work on your DH. How close are you to the hospital...I know that helped my DH get used to the idea, since we're just 8 or 9 blocks away.

Good luck! I just welcomed my second son into the world and it was an amazing homebirth!