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fear of pp hemmorhage

post #1 of 27
Thread Starter 
I went to see my midwife yesterday (there are 3 in the practice, I have seen all of them) and I really felt like she was trying to scare me. She brought up dd's birth, saying from the notes, I had "hemmorhaged really bad". That this time around she will give me an iv prior to the delivery "just in case", as well as a pitocin shot immediately after delivery, regardless of whether everything is fine.

This hemmorhage issue is one of the reasons I decided against homebirth, because it does bring up some fears for me. It was pretty scary with dd, and was the only part of her birth that was somewhat complicated. I feel like this mw was trying to scare me...she left me with a bad feeling (mentioning how women in parts of the world die of hemmorhaging).

Aside from that issue, the mw informed me I have partial placenta previa, and need to get more routine ultrasounds done to check the location of the placenta.

I feel like the mw is being very alarmist. I don't think I should be worried (don't want to be worried)...what do you think?
post #2 of 27
i have a friend who had hemmorage issues with her first two, and did a lot of proactive stuff for her third (and 1st hb) baby. i can email her about it, and get back to ya.
post #3 of 27
Thread Starter 
that would be great, thanks
post #4 of 27
If you have partial previa and you are around 20 weeks its very likely to move up as you progress in pregnancy. I would think one other US at like 36 weeks would be enough. She does sound a bit alarmist and she should have asked you what you felt and thought about PP hemorage and what you thought about what she wanted to do. It should always be a discusion not anyone else telling you what they will do to you. Maybe this is something she is leary of in her practice and is feeling some of her own fears.

I hope you get some more info to ease your mind!!
post #5 of 27
Thread Starter 
thanks for your words Angela that may be true about her own fears...
post #6 of 27
IMO most PP hemorrhage is caused by an overly managed third stage. That's what lead to my nearly bleeding to death with my first. I now UC and, while I still bleed before the placenta comes, I've never bled so much as to risk my life. I've always maintained consciousness and control when no one's pulling at and pushing on parts.

If I were you I'd look up managerial causes of PPH and grill the MW on procedures to let her know you will not permit her to put you at risk for PPH. After all if she's so concerned she insists you'll get drugs to treat a condition that as of yet does not (and might not ever) exist, it would be pretty darn hypocritical of her to put to at risk for that condition.

Originally Posted by mama_y_sol View Post
...Aside from that issue, the mw informed me I have partial placenta previa, and need to get more routine ultrasounds done to check the location of the placenta....
Partial placenta previa is no reason for "routine" U/S. There's a lot of growth that occurs between weeks 32 & 36. Knowing a placenta's low at 20, 24, 28, and 32 weeks means nothing when it comes to birthing decisions. If I had heavy bleeding in pregnancy I'd consider a 36w U/S. If the placenta was still too low I'd do it again at 38w. If it hadn't budged then and was still too low I'd consider birthing in hospital naturally while mentally accepting a cesarean as a possibility *if* I started losing lots of blood and birth wasn't imminent.

post #7 of 27
Thread Starter 
Originally Posted by bryonyvaughn View Post
If I were you I'd look up managerial causes of PPH
I will be looking that up, I appreciate your advice.
post #8 of 27
I totally agree with BVs statements on overly managed 3rd stage. I forgot about that until she mentioned it. I have heard alot of horror stories about care providers rushing the 3rd stage and making things far worse than what they are or seem to be at the time. I would definately research it and then ask her what she practices and then tell her what you want after you research it.
post #9 of 27
from my gf:

alfalfa, rrl tea, chromagen, and nettles i think? it boosted my blood cells so that when i did lose a lot of blood, my body wasn't totally wiped out. it didn't help anything for pp. when the bleeding got out of control, even nursing non-stop didn't do it. they gave me lots of shepherd's purse and that didn't help either. they manually expelled the placenta and shot my leg full of methergen, which finally worked. my midwife usually runs a bolus through for bad pph, but didn't for me. she said in her experience it usually helps mom quite a bit. she did make sure i chugged a ton of water and she was against a wb because of my pph history.

routine iv's are ridiculous. if they really need to get a line in you, it takes a second and they'll get it in no matter what.

the first mw we picked out was alarmist about the pph and immediately talked pit and transport. @@ this baby's pph wasn't ideal and i know it was a lot more medical than most people like, but it was the best management yet and it worked for us.
post #10 of 27
Thread Starter 
thanks Jenn, I printed it up and am going to use it for more research...I really appreciate the time you took
post #11 of 27
no problem! i've never had experience with it personally, but i knew that was a big thing she planned about last time. i hope it can help you in some way.
post #12 of 27
I did not have PP Hemorage with my first, but I did have some heavy, scary bleeding. Also, third stage was not over-managed in my case. I needed a bag of pit after the birth. And 3 years later, I still believe this was a wise decision.

For my second (first homebirth), my MW thought it was advisable to get a pitocin RX for after the birth. She gave it to me, and I had no problems with heavy bleeding. She said that since I am light-skinned I am more likely to bleed. I plan to get another RX for a Pitocin shot this time around.

I completely disagree with the IV recommendation, but a shot of pit after the birth is really no big deal. I know of birthing centers that do this as standard procedure in order to prevent post-birth hospital transfer and it works out very well.

My MW also had me drinking large quantities of RRL tea throughout pregnancy. Perhaps this was related?

Yes, the MW was being alarmist, but since you want the best care possible, keep an open mind about Pit after the birth.
post #13 of 27
Thread Starter 
Originally Posted by leewd View Post
Yes, the MW was being alarmist, but since you want the best care possible, keep an open mind about Pit after the birth.
Thanks for sharing your experience. It is good to know that you had no problems the second time...I actually think I did have a shot of Pit with dd, but there was so much confusion during that time (almost verging on panic) that I had a hard time figuring out what was going on. When I was on the bed, with tons and tons of blood gushing out...I remember the shot of pit (& other things they did) were fine with me.

I just don't want my personal fear (which I intend to work on before the birth) to have me saying "yes" to something I don't need (like the IV, which I refused with dd). I agree with you on the fact that while I want to be well informed & take preventative measures, I am the type of person who likes to keep an open mind
post #14 of 27
I had issues with bleeding after the birth of my dd.(natural birth with a midwife in a hospital) The midwife I met with for my 20 week appointment suggested that I should get a shot of pitocin after the birth to prevent heavy bleeding. I am still wondering if this is something I want to do. But the mw said that I am more likely to have bleeding issues again. This has caused me to feel like I should expect to have bleeding issues and I am already stressing out about the birth. I just want to enjoy the moment of my childs birth rather than worry about bleeding.
Blessings to you mama.
post #15 of 27
Thread Starter 
Originally Posted by mamablueberry View Post
I just want to enjoy the moment of my childs birth rather than worry about bleeding.
post #16 of 27
I feel ya, mama.
I had quite a bit of bleeding PP with dd. The mw and her assistant were very calm, cool and collected and I barely knew there was a "problem". She gave me a pit shot and methrogen pills to take (I can't recall for how long) and pulled traction on the placenta while I pushed it out fairly quickly after the birth. She okayed each of these procedures with us before she did them. She is very experienced (having delivered almost 1000 babies) and non-alarmist. She left us to baby bliss while they dealt with all the massive amounts of blood. Before she left she said to try not to move too much and keep my legs together for 3 days. Being that I was in baby bliss I didn't even think to question until she returned the next day, which is when she filled us in on the below the waist happenings.
I'm pretty sure my excessive bleeding is due to my fibroid, which obviously grows during pregnancy.
When I mentioned this to my new mw (we're moving) I never even thought alarmism was a reaction someone could have, let alone a mw. I'm so sorry that it's happening to you. It definitely creates something you need to figure out how to work through with grace. Thankfully, our new mw was/is awesome. I mentioned that I was looking for a mw who carries pitocin and methrogen and was comfortable with PP hemorrhaging while leaving dh, myself and new baby to baby blissland. She was comfortable with the situation, but is wanting to work with me on creating the birth that I want (once we get to the town we are moving to). This is what I would recommend to you as well, as this keeps coming up for me and makes a lot of sense. Visualize the birth you want...every moment from beginning to end...exactly how you desire...and do this every moment you have spare time. I'm making sure all my ducks are in a row logistically to make me comfortable, then I'm creating the birth I want.
BTW, RRL tea is an astringent, uterine tonic that helps tonify the uterus and prevent PPH. I don't drink it because I had 2 m/c while drinking RRL tea, but lots of women have great experiences with it. I will try it in a strong infusion this time, right when labor starts, to help shorten labor and hopefully help with the bleeding. There are lots of other herbs that help prevent PP bleeding as well, but I don't have time to reference them at the moment...worth doing the research though. Personally I'm drinking red clover, nettle and alfalfa infusion tea for the last 2 trimesters to prevent PP hermorrhage, increase available hemoglobin, tonify the uterus, add lots of B vitamins, folic acid, A, C, D, K, potassium, phosphorus, iron, sulphur, calcium, chlorophyll, nourish the fetus, diminish pain during and after birth, and increase amount and richness of breastmilk - and with a little bit of oatstraw just to calm me down .
Blessings and light to you, mama...may you create the blessed birth you desire
post #17 of 27
if i were you, i would ask for a copy of your previous birth record so you can go over it. this will help you determine if maybe your hemorrhage was iatrogenic.

some things to look for: applying pressure to the fundus immediately following birth, before the placenta has separated; cord traction; manual separation/removal of placenta; things of that nature.

she does sound quite alarmist, and personally, if it was me, i might start considering a switch. especially if you get more bells going off at your next appt. if you have any doubts about your mw's practices *whatsoever* you should find a better fit elsewhere. no sense trying to have the birth you really want with someone who scares you/doesn't share your views.

good luck!
post #18 of 27
Thread Starter 
Originally Posted by riverundine View Post
Visualize the birth you want...every moment from beginning to end...exactly how you desire...and do this every moment you have spare time.
Love the idea, great idea, I am going to start doing it. Thanks for taking the time to write and send some love. I really believe in the power of thought and visualization...I might as well start now.

I most definetly will continue to research the herbs that can help prevent PP bleeding. Thanks for sharing what you are taking.
post #19 of 27
From a slightly different perspective the last time I reviewed the medical literature, the risk of having a PPH was three times less for women who have routine pitocin at delivery (intramuscular), followed by controlled cord traction. This would not support the aforementioned suggestions that interfering with third stage causes PPH.

As for an iv line, I would certainly offer one to women who've had a previous PPH, the three minutes it could take to insert one can be all the time you have.

That said, I only provide information about these things and go with the woman's choices. I work in a rural hospital more than an hour from the closest large hospital that carries blood for transfusion so I am very aware of that time and avoiding situations that would be life threatening when possible.

I understand that the op found it alarming to dicuss PPH with her midwife but certainly if someone has previously had one I would want to mention that this is a risk for one in a subsequent pregnancy and that there are some options for medical management that have been shown to reduce risk. Obviously your midwife was unable to do this in a way that was comfortable for you and it is hard stuff to talk about given it is scary.

Whatever decisions you make I hope all goes well for you this time.
post #20 of 27
I had a marginal previa at 19 weeks with my son, and all that was needed was one ultrasound later in the pregnancy to verify that it had moved (most of them *do* move up as the pregnancy progresses). I ended up with more ultrasounds after that, though, because at that 2nd ultrasound, they discovered I was developing polyhydramnios, so...

I would think the m/w may be being a little alarmist on the hemhorrage front, unless they know what caused the bleeding with your dd (and it was something inherent about your body that pretty much guarantees it will happen with every delivery you have). I mean, if it was just a random happening, wouldn't she play the wait and see game?
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