post-partum hemorrhage and future risk

[swl73]

I'm hoping someone can give me some info here since I now can't stop thinking about this.

We had our first baby 8 months ago at a birth center. It was a natural birth with minimal intervention. Right after she was born, I apparently bled a lot. I wasn't even aware of it at the time. I'd had a 26 hour labor and was just focused on my little one. But the midwife and the rest of the staff apparently had to press hard on my uterus to try to stop the bleeding, and then I had to get a shot of Pitocin because the bleeding wouldn't stop. My husband, who has a medical background and is not one to worry easily, actually thought I was going to die based on the amount of blood and the staff's nonverbal communication as this was going on. But after the Pitocin, I soon stopped bleeding and everything was fine.

I asked the midwife at my 6 week follow-up whether I would be likely to have that kind of bleeding again if we were to have another baby. He said that with my next birth, they would just have Pitocin ready to go for right after the birth and so it wouldn't be an issue.

So I haven't really thought about it much since then. Until yesterday. I found out yesterday that a friend of a friend had a baby last week, and hemorrhaged afterwards, and became critically ill. Three days later she had a stroke and died.

Aside from feeling horror for this woman and her family, I am now also rethinking how safe it is for me to have another child. I know, the midwife said it shouldn't be an issue but that's not enough to keep me from feeling really freaked out.

Anyone have any experience or information on this? I'd appreciate any responses!

[barefootpoetry]

I think it really depends on what caused the hemorrage. Can you look at your medical records from the birth and determine the cause? Some women are just "bleeders" but there can also be different factors in births that can lead to hemorrage.

I had a late hemorrage with my first baby too, and yes, the thought of it happening again absolutely terrifies me. But the chances of that are slim, because I will be doing everything in my power to avoid the factors that caused this hemorrage.

[swl73]

Thanks for the reply. I didn't see my actual medical record but my midwife said that the bleeding was because my uterus "was tired" from the long labor.

What are you doing to avoid the factors that caused the hemorrhage?

[Dabble]

I had a significant hemorrhage immediately after the birth of my son, and am right now about a month away from giving birth again.

I have made sure that my midwife (different from the one who attended DS1's birth) is aware of the hemorrhage, that she read my medical records, and have been following her advice to try to prevent the same thing from happening again.

The midwife and nurse who attended DS1's birth were fantastic, and to this day, I credit their expertise and fast action in saving me from bleeding out. My DH still refers to the midwife as a superhero because he truly believes she saved my life. I was like you, had no idea anything unusual was happening - just focusing on my son, and thinking that my racing heart and out-of-touch floaty feeling were normal. My midwife told me later that she had the nurse ready to make the call for blood, and that if she hadn't gotten it stopped when she did, she would have called for a transfusion.

My current midwife has me taking a daily dose of Floradix, which is a supplement of iron and B-vitamins and can help build the blood. I have also been drinking red raspberry leaf tea daily, as it is supposed to help the uterus contract and slow/stop the bleeding after baby is born. They have been keeping a close eye on my hemoglobin, which has been excellent this time.

Postpartum recovery after a hemorrhage is not fun, as you surely know. It takes so much energy for your body to rebuild the blood that was lost. I remember struggling not to black out every time I stood up for weeks afterward. I want to avoid that this time.

At my next appointment, I may discuss my concerns with the midwife again and see if she thinks it would be prudent to have pitocin on hand.

I hope that gives you some hope as to your ability to give birth again. Of course, I haven't done it yet, but my "numbers" have looked better this pregnancy, and I am confident that we can avoid such a severe blood loss by being prepared for it.

[catchesthebabies]

If you only needed one shot of Pitocin, then it was not a serious hemorrhage. I can't stress that enough. I do high risk births all the time, and we have much bigger guns that than, that you have to turn to in an emergency after pitocin isn't enough. Methergine, Hemabate. Massage and pitocin isn't drastic. Judging by how that sounded, their reactions, you probably needed those interventions, you were bleeding too much, but it was easily stopped. Your poor husband is not used to birth perhaps, it alwasy looks worse when it is your loved one, and the bleeding is mixed with amniotic fluid etc it looks pretty bad sometimes. Or perhaps he was right, who knows. But having pitocin right at the bedside isn't too tough, and certainly not a reason to not have another baby. You are at higher risk of doing the same thing over again, but not much I doubt it. You had a longer labor, which also increases your chances. They can have those other drugs around, like methergine and hemabate if they're REALLY worried. I worry more about someone who's had 10 babies and is over age 40 witha history of bleeding.

[barefootpoetry]

Originally Posted by swl73

Thanks for the reply. I didn't see my actual medical record but my midwife said that the bleeding was because my uterus "was tired" from the long labor.

What are you doing to avoid the factors that caused the hemorrhage?

Well, staying out of the hospital, for one. Very long posterior labor that was both poorly and overly managed by medical procedures...long story short, I pushed for four hours in a bad position, lacerated my cervix, had no idea, a week later the scab on it came off and I hemorraged. Fun stuff!

I'd see if you can get a hand on your medical records. I had to go get mine to show to my HB MWs and I learned sooooo much about what REALLY happened during the birth by looking them over.

[swl73]

Thanks, everyone, for your responses. That does make me feel a little better. I will look into getting a copy of my medical record, and taking floradix.

One other concern this brings up is the fact that our birthing center is an hour away. I wasn't that worried about it first time around, but if having Pitocin (or another one of the drugs Catchesthebabies mentioned) on hand is really the best prevention for a hemorrhage, now I'm thinking, OK, so if I don't make it to the birth center and I deliver on the side of the road...? How will we stop the bleeding...?

Also, to those of you who are pregnant and have a history of PPH, I'm sorry if my post made you nervous! Please don't take anything from my stressed out reaction to this - I'm a worrier by nature!

[kate3]

I think being aware of your history and being prepared ahead of time will be great advantages for your next delivery.

I had a PPH with my third-but it was expected: polyhydramnios, large baby, history of fast labors. I got pit immediately after delivery of the placenta. We had Methergine and Hemebate in the room but thankfully never needed them.

I also agree that if you only needed one shot of pit than your bleeding probably wasn't as bad as you and your husband thought. That's not to minimize your feelings-any bleeding that is more than expected is scary. I think it is very safe for you to have another baby and hopefully it won't be an issue for you again.

[heidirk]

I had a medium bad one with DS. They went straight to Cytotec, which I initially wanted to refuse, but the midwife, and my mom, who was right there, both said, honey, it's not a choice any longer. my placenta was out, my uterus would not contract at all.


Looking back, I'm sure of several things that contributed to the bleed. I was dehydrated, my blood sugar was low, as was my sodium and potassium in all likelyhood. I am going to a.)have a shorter labor(maybe ) b.drink some gatorade every now and again c.) DH is going to force me to eat d.) I will comsume a peice of my placenta.


I'm looking forward to a birth center birth, and I am not afraid, because I'm sure a bad hemmorhage in my case can be avoided.


I don't think you should be worried, just prepared!

[shooflymama]

Sorry, thought I posted last night but I don't see my post here, so here goes again.

DS1 I had a postpartum hemmorage - blood loss estimated at 800cc (though I actually think it may have been a lot more, I didn't let them know fully, I don't think, how massively I continued to bleed postpartum because I assumed it was normal), midwife (the most senior one at the birth center) had to use hard massage, shots of pitocin, methergine (spelling?) until the bleeding slowed, and then a pitocin iv drip. It was a very bloody birth all around. Turns out I had a partial placental abruption. I had a totally (till the stuff to stop the bleeding) intervention-free, very fast labor - 2 hours 15 minutes from first contraction to baby.

I was really scared of pph the next time around, but everything turned out just fine. 8 pound 11 oz DS2 was born in 57 minutes (from first contraction to baby), but no hemmorage at all. Very little bleeding, actually, including postpartum.

First DS was born in hospital with birth center midwife. Due to bleeding when my water broke and overcrowding issues, I ended up at the hospital instead of the birth center, which was just as well. I would have been transferred anyway after the birth because of the bleeding.

DS2 was born at the birth center three minutes after we got there .

Hope this helps, and good luck to you!

[swl73]

Thanks everyone for sharing your stories and thoughts. That does make me feel a little better. And I will definitely need to talk more with the midwives at our birth center if/when we are ready to have another babe!

[Lorette]

Originally Posted by swl73

Also, to those of you who are pregnant and have a history of PPH, I'm sorry if my post made you nervous! Please don't take anything from my stressed out reaction to this - I'm a worrier by nature!

Thanks. Maybe I shouldn't be reading this stuff right now.

[smashlie]

I had a PPH with my first birth, but nothing to speak of with my 2nd. I was worried about it through the whole 2nd pregnancy, but everything ended up fine!

[Lorette]

Originally Posted by smashlie

I had a PPH with my first birth, but nothing to speak of with my 2nd. I was worried about it through the whole 2nd pregnancy, but everything ended up fine!

I needed to hear this!
Thank you!
Did you or your DR./MW do anything different the second time to make it not happen again?