Active Management indicated by previous PPH at 2 weeks postpartum?

[BlueHeronHannah]

I've been lurking around here since pregnant with my first child - ten years ago - but am only now coming out of my shell and posting.

I'm looking for more input as I plan for the birth of my second child in April.  My midwife has recommended active management with a shot of pitocin as the baby's head is born.  I'm not convinced and am having a hard time letting go of a physiological third stage.  I also suspect there's a chance that my previous PPH was caused by active management (by "trapping" material in my uterus) but . . I'd love to hear the thoughts of others.

My first labor was a wonderful 18 hours, natural, no interventions until the third stage.  Because of heavy bleeding I was given a shot of pitocin within a minute or two of my son's birth.  The placenta was delivered quickly and looked complete.  My recovery was unremarkable and there were no indications anything was "off" until I starting bleeding very heavily at 2.5 weeks postpartum.  Within a few hours I was given misoprostol, bleeding increased dramatically, and then an emergency D&C.  Pathology indicated "retained products of conception" - my midwife's guess is that I had another lobe of placenta or perhaps there had been a twin that died early but did not miscarry.  Something doesn't quite line up because I had plenty of milk and nursing did not seem unreasonably painful.  I've read that those things don't match with having retained placenta.

Due to this previous PPH midwife wants to plan on active management . . and I'd really like to be on board with whatever choice is made.  I'd love to hear:

Thoughts on whether the active management of first labor could have led to my later postpartum hemorrhage? 

Thoughts on whether active management is indicated by this set of circumstances?

 

Thoughts on whether there is a way to balance my desire to maximize benefits for the newborn (delayed cord clamping, gentle transition for the baby, etc) with making choices that are safe for me based on my history?

 

Thanks so much!

[BlueHeronHannah]

After reading more I wanted to add that it may have been methergine that I had during my hemorrhage rather than misoprostol.  Misoprostol was the word in my head . . but that was almost ten years ago!  I am planning to check on that at my next appointment.

[womenswisdom]

It sounds like you basically had active management last time and that the issue you experienced is unlikely to occur again. It may be policy to recommend active management for anyone who has previous had a pph, but your situation is fairly unique. I can't see how doing the same thing (active management) would prevent the problem that it failed to prevent last time.

[BlueHeronHannah]

I appreciate your thoughts!