UC with history of PP hemorrage

[earthmama4]

DH and I are currently TTC and I have a great desire for this pregnancy and childbirth to be unassisted. It will be my 5th birth. I have had 2 c/s followed by 2 vbacs. My vbacs were induced and I received large amounts of pitocin for long periods and after both births, I bled heavily in the recovery room. It is this bleeding that has me somewhat concerned about our ability to have an unassisted birth. My last birth two years ago was the worst. I am not sure what severity of bleeding I had. I did not require blood, but the nurses all scurried and acted concerned and they would not let me go to my pp room until it was "under control". They gave me additional pitocin, followed the methergine shot and intense uterine "massage." They still kept weighing my pads and looking concerned and kneading the crap out of my belly for nearly two hours. Oh that hurt. The bleeding was said to be from my uterus not "clamping down" after birth, and not from placental retention or anything. 

I now believe it to be the side effect of an overworked exhausted uterus that had been hammered with a long labor of pitocin. Every 30 minutes, they just kept turning it up, up, up even when I was in transition! It was around 10 hours with DS3 and 15 hours with DS4. I was not aware until recently that pitocin may have played a major role in the bleeding, as well as the terrible jaundice that my infants suffered. :(

I am fully confident in my ability to birth vaginally and in the strength of my uterus to bear the strain of a natural labor, but in order for me to be fully able to let go of all fear, it would help to hear opinions and explore my options for preventing heavy bleeding after birth. I am very new to the world of unassisted childbirth and so book recommendations, videos or websites would be appreciated. And if you feel given my history that UC would be unwise, please share as well. 

Thank you!

[Ekatherina]

:hugs just wanted to send you hugs....:( i am sorry you had such terrible birth experiences. my friend's sister bled and needed several blood transfusions during labor due to as they said "her uterus that wan't contracting" but I suspect and she suspects as well that it was all about nurses severe interventions, maybe pitocin as well......I had dd at home, although my first labor was very hard (40 hours) and almost ended up in the c-section. I was sure that hospital was at the beginning and end of my sufferings and trusted my body. we didnt go to UC though, because our parents were too concerned. it was with a midwive. I would suggest you try to find a midwive you trust at least to be more relaxed that someone would take good care of you if something happens. Otherwise you could buy an emergency kit and have an agreement with some hospital nearby where your dh can drive you in case if an emergency. But whatever you decide there must be always a back up plan! Noone knows what could happen, you have 4 kids so you dont want to put your life to risk. I really wish you best of luck!! 

[kittywitty]

I had a pph with #2, a bit more bleeding than was liked with #1, and a pph due to a piece of retained placenta with my uc (#4). I just had #5 with a very hands off mw due to my pph fear. I had zero pph issues. My placenta came out with no issues and my bleeding was normal. Since I had no pitocin given to me, my afterpains were much more bearable, the bleeding did not last as long and I had less large clots. It really is your choice. I knew I couldn't get over my pph fear this time and it was nice just to be able to ask my mw "is this normal?" and have her there just in case, for me. There are some good pph threads in this forum I would check out for sure. Just know that every birth is different. Just because you have a pph before, doesn't mean you will again. It's important to look at the causes of the pph. I upped my Vit K with a supplement and drank RRL/oatstraw/nettle/alfalfa tea a lot during the 2nd and 3rd trimesters. I think that really helped a lot.

[Almi]

I personally think that a lot of birth complications arise due to hospital interventions, including PPH.  Just my two cents.

[greenmama66]

I've had all mine at home with hands off midwives and have had 2 PPH with 2 births (why I called in the MW last time). I did end up getting pitocin shots both PPH times as herbs weren't doing it after we waited a couple of hours. That's been my fear with UC and I keep going back and forth on UC or calling in a MW this time around. Of course there are things one can do to help prevent a PPH and I am going to do those (yarrow in last month, alfalfa, lay off the fish oil in last month and have some serious herbs on hand as well as Yunnan Paiyo).

[Sijae]

While it is true that a history of postpartum hemorrhage increases the risk of another one, I think it really depends on the cause of the original hemorrhage. It is a known fact that pitocin augmentation increases the risk of hemorrhage from uterine atony.  When you are given pitocin in labor, not only does it artificially force your uterus to work harder to the point of exhaustion, but your body has safety mechanisms that it uses to protect itself from the pit.  Basically the receptor sites for oxytocin decrease so that the pit isn't being as effective.  Then they turn it up to keep getting results and it happens all over again.  Then when the baby comes, not only is the uterus tired, but it has decreased its receptor sites so much that it doesn't respond anymore to either pitocin or oxytocin.

I really believe that a labor that begins on its own, and flows at it's own pace is also able to end on its own with healthy uterine contractions.  Remember that in a UC you will be in an environment where you feel safe, private and unobserved.  Instead of pitocin that comes from a needle and only effects your body (pitocin can't cross into the brain from the body), you will be making your own oxytocin which is made in the brain and gives you all the benefits of that "hormone of love."  You will push your baby out when you are ready, and your baby will be right there with you afterward, in a beautiful bubble of love, helping your body to crank out that oxytocin like never before and clamp down your uterus.  Finally you will birth the placenta when you are ready, not with a shot of more pit combined with cord traction.

It's also useful to note that the definition of "hemorrhage" is 500 ml (2 cups) which is the same amount that non-pregnant women give in a standard blood donation.  Healthy, well-nourished women have a significantly increased blood volume which means they can lose more blood before seeing effects than that non-pregnant woman.  Most women can lose at least 1000 ml before seeing affects of blood loss.  And most women have a working body that knows just how much blood to release and when to stop bleeding.

Medical personnel are trained to fear birth and especially bleeding after birth.  They are taught to do dangerous things to the body (pitocin) and to force the placenta to birth quickly through "Active management of third stage" which includes cord traction and more pitocin.  Of course they were afraid, they knew you were more likely to hemorrhage with that kind of induction, and they fear birth.  If you didn't receive blood products it is unlikely that you had what I consider a true hemorrhage which is a blood loss that results in symptoms of shock.  You probably lost more than 500 ml but perhaps you lost a normal amount.  Either way, if caused by the induction it is unlikely  to repeat itself in a physiological birth.

[Almi]

^ Well said.