"Normal" Blood Loss?

[cadybh]

My apologies if this has been posted previously, I did a search and couldn't find what I was looking for exactly.

We are planning a home birth with this pregnancy after being induced (for no medical reason other than "post term" at 42w1d) - which overall went well, but made my choice to go natural very difficult; with the Pitocin cranked up every half hour, I caved and took a dose of nubain, which frankly wasn't worth the side-effects, sheesh.  As far as the home birth goes, my main concern has been that I did experience what I think is technically a postpartum hemorrhage with DS' birth, a total blood loss off approximately 800 mL according to my medical record.  I am not sure if that is a lot for a vaginal birth, enough to be a concern or just sort of "average" considering an induction, a post-term baby, a 3rd degree tear, etc.  Thoughts or experiences that relate, anyone?  Thanks for any reputable links or any information!

And - a caveat - of course, I have put the message in to my midwife and will heed whatever she says; previously when we've discussed it she has stated it may be normal for me (I have VERY heavy periods, soaking through super absorbency products in under an hour for 36 hours each cycle), it may be normal for a Pitocin induction, every birth is different, and that they bring supplies to handle the issue on a routine basis.  Now that I know the actual amount of blood loss since receiving my medical records this week, I will discuss it with her specifically at our next appointment 1/8/13, I just thought I'd ask here in the meantime.  

[silversparrow]

Normal blood loss at a vaginal delivery is considered less than 500mL. Anything above that is usually reason for further action. However, a hemorrhage can be any amount with the potential to cause symptoms. Some women can handle 750-100mL with no problems, others may have symptoms with only 400mL. An induction and 3rd degree tear definitely increase the risk of blood loss, and these are circumstances that you are unlikely to experience again. Some midwives will recommend raspberry leaf tea to keep you uterus toned. If you are hoping to avoid routine oxytocin injection after the birth (especially since it can increase afterpain, which are usually stronger with your second baby), discuss this with your midwife and plan to start breastfeeding as soon as possible. She will likely recommend giving it if you labour has been particularily fast or slow, if your baby is big, has trouble getting the shoulders out, or needs some resuscitation, or if she sees bleeding that isn't slowing or the placenta isn't separating. She may also recommend that you have an IV lock in place in case you need fluids. Unfortunately, having a previous hemorrhage, symptomatic or not, does increase your risk of another, so she may make recommendations so she feels comfortable with your homebirth.

Good luck!

[JamieCatheryn]

I like to take my iron supp, maybe some chlorophyll, and drink some OJ, and get covered in a blanket almost immediately after birth to help keep me together no matter how much blood I lose, I don't lose much but am prone to lightheadedness. Homebirth midwives start doing things (ask you to focus on slowing your bleeding, have you breastfeed or do nipple stimulation, give tinctures, consider giving Pit, consider calling paramedics) after over what looks like 1 pint (about 500ml), which is on the upper edge of normal loss. By 800ml she'd be focusing on tending to it for sure especially if you felt unwell. I am told after having Pit earlier on, women are more likely to need some in third stage also to prevent excessive bleeding.

[cadybh]

Thank you both for your replies, lots of good information here!  MW is coming over today for a prenatal appointment and I'm eager to hear her thoughts.  Silver, I didn't realize the shot after would make the after pains more severe, good to know.  I was originally thinking what would the harm be.  Jamie, those are some great concrete tips of easy things for me to do post-birth.  Jamie, how does the chlorophyll help?  Just high in iron like green leafy foods?

[JamieCatheryn]

I think they say chlorophyll helps you make more blood and restores blood nutrients..

[Briannasmom]

I had a PPH after my first birth (which was at a birth center).. so I too was worried about it my second (and third) time around :)    My midwife had a great plan for me that made me feel at ease with birth again - everything from watching weight gain (so uterus was smaller, I guess?) to visualization (seeing my uterus clamp down) to herbs (don't remember which but she gave me a bunch after the birth).  My second birth I did bleed a good bit still, but she had pitocin (which didn't work for me to clamp uterus down) and methergine (which did work to stop the bleeding).  I was so grateful to stay home and not have to hospital transport like I did the first time.  With baby 3, I barely bled at all.. the shot of pitocin did it for me.  A good midwife will definitely have a game plan for you!
 

[IdentityCrisisMama]

I had a PPH with my first birth. Hospital transfer after 3 hours of pushing, baby born unmedicated at hospital after 1 hour. I wasn't clamping down and MW did uterine massage, lots of blood loss followed. I don't remember how much but I was given a transfusion. I was worried about the second planned HB mainly because of how long the recovery period was from the blood loss. For my second birth I did bleed a bunch, was light headed and etc but it was much better. I was willing to do profilactic pit but opted for methergrine instead. I may not have needed it but I desperately did not want to transfer and wanted to be home alone with my DD and let my MW go home. 

[cadybh]

Thanks for the stories, ladies!  It helps to know others who have been in the same situation and successfully stayed home.  

At my appointment Tuesday, my MW said she wasn't worried about the loss.  She said it could be explained due to the use of Pitocin for the induction, plus that I did not heed warnings to slow down pushes and tore (3rd degree), PLUS that DS was on the large side (9 lbs 4.5 oz).  She said that's not so high they'd be worried but would just be prepared as normal (massage, herbs, drugs if needed, etc.) and we'll keep a close eye on things immediately following delivery.  She doesn't even think it warrants an IV lock (whew - I am needle phobic).  I started drinking RRLT yesterday and will keep that up daily, which can't hurt.  She was very reassuring and I feel much better after speaking with her about it, plus hearing all of the stories and tips from you all.  I am going to be sure we have some iron-rich foods/snacks/drinks around when we get to 36 weeks to help boost my stores afterward, and we didn't do this last time but this time we'll do placenta encapsulation - that should help recovery, yes?