Abdominal pain between contractions, hemorrhage, inability to urinate

[MamaMochiko]

I had a great homebirth a little over a year ago and I am pregnant again.  I don't really understand what happened to me last time but I am beginning to think more about it and wonder if something was going wrong and nobody noticed it.

I was in labor for 24 hours with 12 hours of active labor.  My stats and baby's heart rate remained normal.  Nothing of any particular interest except that about halfway through I kept trying to pee and I could barely squeeze a drop.  At around 8 centimeters I realized I had abdominal pain between contractions, not severe, but enough so that I felt cheated because I was unable to relax between contractions.  The MW felt my stomach and announced that it wasn't hard/contracting between contractions and something about it was good that I didn't feel like there was anything wrong.  I didn't notice the pain very long because not long after I was ready to push.  After the baby was born the placenta came out quickly, I want to say within ten minutes.  I felt fine but the MWs were concerned with bleeding; they had me walk to the toilet, where of course I could not pee, and told me they wanted to give me methergine for the bleeding.  I got methergine and pitocin and I was still bleeding but I felt fine.  They called the OB and he said to check for clots.  They had to remove a few clots and then after they removed one large one I stopped bleeding.  I still could not pee so I had to get a catheter.

I remember learning in Bradley class that physiologically after a certain point the pee would be trapped but I didn't expect not to be able to pee after the birth.  I aksed my MW during a postpartum visit what happened and the explanation went over my head; she didn't seem too concerned and I was fine after all so I didn't give it a second thought until now.  The MW mentioned something about the position of the placenta and the bladder.  I will ask her again and I will let you all know what her explanation is but I am worried that I might have had placental abruption and she didn't recognize it or didn't think it was serious enough for a transfer.  Obviously I'm fine and I'm ready for another homebirth but will have to reconsider if what happened was indeed placental abruption.  

I had no other signs, no bleeding in pregnancy or during the labor.  I saw my placenta when it came out then we froze it and thawed it and handled it later and it was beautiful, a rough side and a smooth side and no parts missing.  

[CEG]

I would be inclined to think your full bladder was causing you pain and the bleeding.  It's possible that it was an abruption but pretty unlikely.  Your placenta probably would have had some noticeable areas of change if there was an abruption. 

[womenswisdom]

An abruption occurs when the placenta separates during labor. It doesn't seem like that's what happened in your case though, since your baby was born healthy, there was no bleeding during labor and your placenta appeared normal and was delivered in a normal amount of time after the baby (not on the baby's heels). I would be inclined to think that it was your full bladder that was causing the abdominal pain during the last part of labor and swelling causing the inability to urinate after the placenta was out. A full bladder can keep the uterus from contracting normally and can contribute to excessive bleeding postpartum.

[MamaMochiko]

I can see how that could be very possible.  Thank you, I will sleep well tonight.  I will discuss it with my midwife, but if it were to happen again I am curious if getting a catheter sometime earlier in the labor might help.  

[Emelee]

I thought I'd add that during my birth her shoulder was square on my bladder making it very painful even between contractions. It was when I finally pushed her shoulders into my pelvis that the pain stopped. It also was a bit difficult to urinate right afterward but with a little patience I was able to on my own. I was cathed during labor because they thought it was a full bladder but nope, it was just her shoulder. Hope that helps!

[MamaMochiko]

Thank you for sharing.  I definitely felt better once I started pushing, too.  Good to know that I can be cathed in labor if necessary.  I don't think y MW noticed I couldn't squeeze anything out because I kept walking around and sitting on the toilet : )

[Katie8681]

I don't want to Monday morning quarterback, but with the symptoms you described, the very first thing I would have done is catheterize you.  If not in labor, certainly when you were bleeding excessively postpartum.  Getting cathed is no good time, but if a full bladder is the problem and you can't pee, voila!  Instant cure  :)

[prothyraia]

Originally Posted by MamaMochiko 

The MW felt my stomach and announced that it wasn't hard/contracting between contractions and something about it was good that I didn't feel like there was anything wrong.

It sounds like she was checking for abruption here; a rigid abdomen between contractions is one big red flag. So it seems like she was on top of the situation when you were having pain.

I have the worst time peeing after the baby is born. I swear, it's harder than pushing out the babe!

[katelove]

I agree, it does sound like our symptoms could be explained b a full bladder. As to why you were unable to pass urine afterwards - sometimes the urethra gets kinked or swelling of surrounding tissue puts pressure on it, making it difficult to wee until it has resolved.

An "in, out" catheter is a good solution, especially so close to the end of labour. It drains your bladder and is then removed so you don't have the discomfort of an indwelling cath.

[MandyGail]

I had a very similar experience during my homebirth- although I also had problems peeing before I went into labor - into the last few weeks of my pregnancy.  I had a moderate pph, but when she cathed me the bleeding stopped - I also recieved a shot of methergine, had to be on oxygen, passed out for a short period.  It was very scary & I dont want to go through that again so I asked about being cathed during labor & she agreed that it would probably prevent that from happening again - I never had any problems with my other births with respect to this - but they were all hospital births & i had an epidural so I had the catheter automatically...

Hope it goes well for you this time!!