Talk to me about post partum hemorrhage

[snowbird25ca]

I bled a ton immediately after dd was born when the placenta detached, and so my current OB has written PPH on my chart for previous pregnancy history. #1 was an induced labor with pitocin, so I didn't have any bleeding problems afterwards, but dd was a natural labor and I ended up getting hooked up to pitocin after my placenta had delivered.

This time around I'm really stressing about delivering at a different hospital with a different dr. and having to deal with whoever is on call for pediatrics. We're refusing the vit K shot & eye ointment, and I want to not clamp or cut the cord until it's stopped pulsing and be able to nurse the baby before any weighing or anything. And I'd like to avoid the agressive suctioning if possible...

Most of these things I know are doable in hospital, but the suctioning and not having the baby taken straight to the warmer right away are what I know are going to be more difficult... and I'm really starting to lean towards accidentally having an UC at home. Once I'm in hard labor things go fast, so I think that it could happen easilly enough by "accident"

So I guess I'm wondering if previous pph means it'll happen again, is there anything I can do to prevent it or reduce the likelihood, and is it a dumb idea to even consider just accidentally having an UC?

My OB has agreed to having a heplock in place instead of a full IV while I'm in labor just so that there's easy access, but I've read a few mention of herbs that can be used... I puffed up more and retained more fluid from the oxytocin than I did when I was 9 months pregnant in July. :

Hopefully this made a semblance of sense.. any input, suggestions, experiences etc would all be very much appreciated.

[lizabird]

I have a family historoy of post partum hemmorage. My great grandmother died, my mom was in the hospital for a week after I was born...

So given this information, which I told my midwives at a birth center, they agreed that this was something to consider. We agreed that after DS was born, I would get a shot of pitocin. They just gave one shot to me in the thigh after ds arrived and was happily snuggled on my chest. I didn't have any problems. Who knows if I would have or not, but that's just not the type of chance I wanted to take, especially since the birth center sends people home after 4-6 hours. I'm surprised that in the hospital they would hook you up to an iv... but then I guess I shouldn't let any crazy hospital stories surprise me, I hear a lot of weird stories like that. Anyway, with baby #2, same birth center, same family history, I am getting a shot of pitocin again. No IV or anything, just one shot in the thigh after baby arrives. Maybe you could ask about that possibility?

Good luck!

[snowbird25ca]

Thanks for replying.

Hospitals here automatically give the pitocin shot after delivery, but it wasn't enough last time. Maybe they just didn't give it long enough?

[Full Heart]

So I guess I'm wondering if previous pph means it'll happen again, is there anything I can do to prevent it or reduce the likelihood, and is it a dumb idea to even consider just accidentally having an UC?

Just cause it happened once does not mean it will happen again. You can reduce the likely hood by not having things like pit. Nurse immediatly after the birth, pee often during labor and soon after the birth, don't pull on the placenta.

I have had a pph after #2 (to the point I passed out), I have had 4 more children since then and have not had another pph. I also had those all at home. I took precautions to pee alot during labor, waiting for the placenta patiently and I had shepherds purse on hand (my mws also had pit and methergine if I needed it).

I don't think its dumb to have a uc. You should ask the uc forum about pph.

[onlyboys]

The only of my births that I bled too much (the CNM called it a PPH, but honestly, I saw how much blood there was, and I think it was not quite there) was the birth where I got pit.

The rest were peachy-keen.

Maybe you can research PPH and pit induced labors to see if you see a correlation before you make your choices about what interventions you want this time around.

[snowbird25ca]

Hmmm, that's interesting about pit induced labors increasing risk of pph. I didn't hemorhage after my pit induced labor but did after my natural labor. Guess I do things backwards...lol.

Just to clarify though, this won't be another pitocin induced labor. No way I want to be hooked up to an IV through my whole labor. Although there's plenty of other good reasons too...

Thanks for the suggestions, I'll have to do some more research. It's also nice to know that having had it happen once doesn't mean it'll happen again.

[CJ 5]

I had a very skilled midwife. She told me that if you have a heplock and administer pitocin for the placenta only it reduces risk of PPH to almost nothing. This was based on a pretty thorough study.

Personally I have thought about having a shot of pitocin after birth to ensure safe delivery of the placenta especially if I home birthed. your doctor actually sounds very reasonable. Some are purely into inducing and and all that.

[ABand3]

I had pph after all three of mine (sorry to be the downer!). The first two at a fsbc, third at home, no induction or other meds during labor, no pulling to get the placenta out.

I had a shot of pit (and a drip the first time) and methergine after the birth of the placenta each time, when it became apparent that the bleeding was excessive. The first two times I felt fine, hemocrit wasn't too low, blood presssure was fine, the third time my bp bottomed out and I fainted, and then transfered from home to hosptial - probably didn't need to, but did as a precaution. I didn't have a heplock and once my bp fell it was difficult to get a line started. If I were to give birth again (no plans for more, but if) I would have a homebirth agian, and request a heplock in case of hemmorage.

At my midwife's recommedation I loaded up on vitamin K in the month before I was due - like a cup of sprouts every day. Apparently it didn't help. I also have a terrible time peeing during labor (to the point of asking for a catheter ), so I wonder if there's something wonky in my anatomy and the full bladder leads to a uterus unable to contract?

[snowbird25ca]

AB&3 - How scary for you. Glad everything turned out ok. My hemoglobin is naturally on the high side, so even though I lost a lot of blood & was weak for a good month afterwards, thankfully I didn't need a transfusion.

CJ 5 - My OB is really non-interventionalist - if that's a word. She's really let me take the lead which I really appreciate, I just know once I'm in hospital it may not be her delivering and you just never know what could happen...

On the plus side, I'm strong willed & not afraid to demand what I want & refuse treatment I don't want, so I guess that makes me more likely to have another positive hospital birth. It's really dealing with the on-call ped more than anything that makes me nervous. I can handle myself, but I worry about the hospital calling in CPS over the vit K or something... Maybe it's just paranoia.

I've started drinking alfalfa tea & nettle tea to help raise my vit K & iron in preparation for delivery. I'm also drinking rrl tea and hoping that it will decrease the likelihood of pph. My dr. seemed to think it was a result of fast labor & my uterus stopping contracting because my dd delivered so fast. Not sure how this labor will be...

[cottonwood]

I don't know too much about prevention in terms of diet, you might try on the midwives forum and the UC forum too. One factor in making PPH more likely is if third stage is disturbed in any way -- usually (even in homebirth) that's when everybody acts like the birth is over, the lights go on, people start talking and rejoicing, the baby is taken to be cleaned and wrapped up, mother is instructed what to do to get the placenta out... all of these things interfere with the hormonal release that is responsible for a normal third stage. If you're already susceptible to PPH, that could just be the straw that breaks the camel's back. And then of course there are invasive ways of managing third stage such as massagin the mother's uterus (should NEVER be done before the placenta is detached), applying cord tractions before the placenta has detached fully, etc.

Ingesting placenta is also thought to be very effective in stopping PPH, and there are herbs that can help (shepherd's purse, for one) as well.

[Mama Dragon]

Tell you what - I have hemmoraged 4 times in my life: the 4 times I had pitocin at the hospital (with 3 kids and 1 D&C). I bled a fair amount after my UC, but no where near as much as before. I'm a typical bleeder too - -red hear, fair skin, family history. But my bleeding was very easily managed by NOT using pitocin.

[snowbird25ca]

Originally Posted by fourlittlebirds

I don't know too much about prevention in terms of diet, you might try on the midwives forum and the UC forum too. One factor in making PPH more likely is if third stage is disturbed in any way -- usually (even in homebirth) that's when everybody acts like the birth is over, the lights go on, people start talking and rejoicing, the baby is taken to be cleaned and wrapped up, mother is instructed what to do to get the placenta out... all of these things interfere with the hormonal release that is responsible for a normal third stage. If you're already susceptible to PPH, that could just be the straw that breaks the camel's back. And then of course there are invasive ways of managing third stage such as massagin the mother's uterus (should NEVER be done before the placenta is detached), applying cord tractions before the placenta has detached fully, etc.

Ingesting placenta is also thought to be very effective in stopping PPH, and there are herbs that can help (shepherd's purse, for one) as well.

Hmmm, that's interesting that an emotional change of pace could affect things. I do remember just feeling so relieved that it was over & the ctx were gone. My dr. was really great with delivery, she left me completely alone during 3rd stage until I asked if I had more amniotic fluid coming out & she said nope it was blood and just meant my placenta was ready to come out. But the bleeding just didn't stop right away even after the placenta was out so that was when she tried massaging my uterus and when that didn't make a quick difference & the pitocin shot didn't make a difference I got hooked up to the IV & given pitocin...

I think part of the problem is that when I bleed, I really bleed... I bruise easily too, so who knows, maybe it's just the way I am.

Synthea - By typical bleeder to you mean "average," or do you mean that you're more prone to bleeding that most people?

[BelgianSheepDog]

Hmm...have you had your clotting factors checked? MIght not hurt, since you say you bleed easily in general.

[Mama Dragon]

Synthea - By typical bleeder to you mean "average," or do you mean that you're more prone to bleeding that most people?

Sorry - I mean that I bleed more then most. With this one, I lost 2 liters according to the doctor who sewed me up post UC, and he said he only likes to see a mom lose 1. But I felt wonderful. With my other's, I lost much more then that and I could tell, I was weak for some time afterwards.

I did buy Shepperd's Purse (ground, and put it in blank pill capsules) just in case I bled too much.

[shell024]

I hemorrhaged after ds was born by UC at home. THe placenta wasn't coming out yet, so I nursed ds ASAP but he wasnt interested, so I used nipple stimulation so that my uterus would contract some more. THis helped slow the bleed a bit, and also sped up the birth of the placenta. Once the placenta was birthed, I ate a small chunk and the bleeding stopped almost instantly. I nursed ds, STAYED RELAXED (so important! Anytime I moved unnecessarily or became tense, more blood would show up), drank tons of water & ate a good meal with plenty protein. Next time around I MAY have some sheperds' purse or angelica if the placenta is taking too long and I am hemorrhaging. Ingesting the small piece of placenta was the only "instant" remedy that I observed IME, but I didn't have any herbs on hand to try.

[courtenay_e]

Depending upon who attends you, don't tell them you want to wait till the cord stops pulsing, 'cause they NEVER do. Instead, mandate that they wait to cut the cord until the PLACENTA HAS DELIVERED, AND have a doula there to be SURE that there's NO cord traction going on, nobody touches your fundus, etc. That's what I'd do.

I also hemorraged after my son's birth, but it was ten days later. It was such an awful experience, though, that IF I were to have another baby, I am also seriously considering the pit shot, and THEN going home with methergin pills, to be sure that I continue to contract firmly post partum...

that said, everything surrounding ds's birth was chaotic and stressful, except the hour and a half before the birth. We were home for a day and had to check him back in because of severe jaundice, they woudn't LET both parents "sleep" in the room at the same time (so dh couldn't take CARE of me while I was taking care of baby)... I am quite sure that that chaos contributed to the bleed out. BUT I dont want it to happen again. I just don't. And I'm about as non-interventive as you can get, but I simply believe that the drugs, used wisely, are there and useful in some circumstances. Will I look into shepherd's purse (I have it in tincture form in my birth kit in CASE for some awful reason I'm alone with a mama when she births and then she hemorrages) rather than methergine pills for post partum use, but really, if I know that it works (and it did work after the hemorrage to keep me clamped down), and I don't want to take the chance? I am certainly leaning toward taking the drugs. AND, they DON'T have to give it IV. If the shot doesn't work subQ, they actually gave me my shots directly into the uterus when they couldn't get the bleeding to stop. Not COMFY, but effective...don't know if they can only do that with a spinal, or what, but that's what they did for me. Perhaps you can ask about that?

[snowbird25ca]

Thank you so much - I will definitely ask if giving the pit through a shot into the uterus is an option in an emergency situation. I'd rather that than the IV... and that way I wouldn't be hooked up to it for the 12hrs afterwards & puff up like a balloon.

I did have my clotting factors checked earlier in the pregnancy & it's possible I have a bleeding disorder, but they couldn't say for certain because pregnancy hormones change the clotting factors. I'm still waiting for an appt with a hematologist to discuss the possibility though.

I think I'll look into the shepherd's purse & putting it in capsules. Not sure if the hospital would have a cow about that, but I'm still seriously considering accidentally having baby at home. : Although I highly doubt dh would let me get away with that.

[BelgianSheepDog]

Previous hemorrhage doesn't rule out homebirth on its own, though I think if you have a clotting disorder that might. Hopefully that's not the case though.

Was your labor really long last time? Uterine atony (tired uterus that contracts weakly) is one of the main causes of hemorrhage. Being at home is a good way to prevent that, since you're less likely to be stressed and more likely to eat and drink plenty.

I'd talk it all over with a midwife, I bet you could work out some good solutions.

[Nora'sMama]

My mother had PPH when I was born (and almost bled out before it was discovered - very, very scary) and I always thought that this may have happened BECAUSE she had a Pit-induced labor, because the Pit contractions tired her uterine muscles. But I don't remember exactly where and why I came to this conclusion. I was very frightened of PPH and because of my beliefs about my mom's experience I was determined not to have any Pitocin (I didn't, and I also didn't have any bleeding problems).

Does anyone have any further info on the Pit induction-PPH connection, if there is one?

[snowbird25ca]

My actual active labor with my dd wasn't long at all. Total time from having an inkling that labor might be starting to holding dd in my arms was 18hrs, I woke at 5am thinking today was the day & had intermittent ctx all day, but nothing painful, I was just aware they were there... I wasn't sure it was labor until around 6:30pm when the ctx got more regular and felt different, and she was born at 5 minutes to midnight.

My water did break when my dr. checked me at the hospital & I was 4cm's. That was when I was admitted & it was 10:30pm. Do you think that could've had anything to do with it?

My dr. actually seemed to think that it was the rapid labor that led to my uterus stopping contracting & the bleeding. So who knows?

I guess I need to call a midwife & see if one will talk to me... they're hard to find around here & book up really fast. And provincial insurance doesn't cover them unfortunately which is why I haven't been gunning for a homebirth right from the get-go. $3000 compared to $0 is a lot of money. Although if I had the extra kicking around it would be more than worth it....