History of PPH...Considering UC with MW backup...

[micah_mae_]

Ok so with my first birth it was augmented when I was 5 cm and not actively laboring. The mw's used AROM to get things going. AROM locked him into an asynclitic/nuchal arm position. Took 2 hours to push him out like that and he was 10 lbs 7 oz. After a few minutes the midwives drained the tub and asked me to push the placenta out, I pushed and there was an explosion of blood..all over the walls and everything. It was very...interesting. I don't recall if they used traction or not but I bled a lot. I had tachycardia afterwards with my heart rate around 200. Standing up/walking made it to where I could breathe but didn't feel like I was breathing/oxygenating. 

Second birth was textbook, baby came out in 5 min, 9 lbs 13 oz. The midwife seemed freaked out by the amount of blood/clots I was losing. She kept asking me to push for the placenta but instead clots kept pouring out. She almost manually removed the clots/placenta but I screamed at her not to so they used a lot of fundal pressure instead. I still bled a lot and suffered some tachycardia/breathing problems but not as bad as with my first. Again I don't remember if she used traction.

So now I'm due with my 3rd in a couple months. My midwife seems to be worried about my history of bleeding/pph.

Part of me wants to just wait after the baby is born for the placenta to come on it's own, but apparently I start bleeding a lot before the placenta comes so I'm torn.

Any ideas or thoughts? I just want a relaxing time after baby is born, for once. I'm considering UC'ing and calling the MW afterwards (Oops, too fast!). Would that be foolish with my history?

[womenswisdom]

Yes, I think it would. I do understand the desire to have a relaxing time after the baby is born but not only have you had what sound like pretty severe hemorrhages with both labors (in different circumstances), you've had health effects (tachycardia) that indicate significant stress to your body. The tachycardia is what your body does first as it tries to compensate for a large blood loss. This puts you at higher risk for this happening again. It sounds like what happened is that your placenta separated but did not deliver in a timely manner, which caused your uterus to stay boggy and bleed excessively.

What would be your plan if you did decide to UC? With your history, it seems prudent to be assessing your uterine tone and fundal height, determining if the placenta has separated and taking action get it out and to monitor blood loss and manage a hemorrhage if it were to occur. It seems like that would not be more relaxing than having your midwife there to monitoring those things and take action if needed. Not having her there is not going to prevent a hemorrhage. Unless the midwife lives next door, calling her during a hemorrhage will not be quick enough. You may be left calling EMS, who do not carry anti-hemorrhagics. Quick action to manage the hemorrhage before it got too severe is probably what kept you out of the hospital with the previous births. It may be odd to see on the UC board, but some clients choose to have routine postpartum Pitocin in a situation where they have had significant PPH in previous births in order to help prevent the same scenario, so that could be an option to consider.

[micah_mae_]

Thanks for speaking truth to me, I know you're right. I'll talk to my mw about a pit injection shortly after birth to hopefully help. My body is great at making, growing and birthing babies..just sucks at the rest.

[BlessedJess]

I've got an idea for you to consider - cayenne tincture. Do a little research on it.

I wouldn't want to do a UC if I was scared of blood loss unless I had a connection with a MW who was more like Gloria Lemay than anyone else. I would have her nearby or in a room in the same house. I would be really really picky about the midwives even if you wouldn't consider UC. You need a woman who undestands and trusts the third part of labor and knows how to prevent the same thing from happening again.

Frankly, I suspect that the midwives might have caused all this mess themselves. Don't use the same gals. And don't do anything after birth to lower your oxytocin levels. Example; Don't hire a midwife who will humiliatingly push you around to save you from your placenta. She could actually cause the problem she fears just by getting a negative emotional reaction out of you. Let the people closest to you be your romantic partner and your babies you already have who make you release oxytocin when you see them. Have everyone else get back and let you embrace your new baby without interference or pushing you around. YOU call the shots at your birth and make sure others understand why. You stay safe and be nurtured after birth so that you feel like a beloved queen. This is your moment. It's not a game, it's your life and without proper emotional support you won't have the oxytocin you need to keep from bleeding out.

Often women do bleed more heavily than other women as their own version of normal, me included, but my last birth (6th) I bled very little, even though I've bled till I was weak/shaky in the knees many times before. Make sure someone watches over you and helps you to the bathroom when needed for the first 24 hours minimum. Beware of the later postpartum potential for bleed out in the following week.

[BlessedJess]

A pit injection might help but I would try to avoid that if at all possible to avoid coming down from the artificial hormone - only to bleed out later with reduced natural hormone backup.

[darkblue0729]

Shepherd's purse is pretty awesome for PPH. Good luck mama!