What would a midwife do if....

[mama2be11]

When I had my ds (only 6 weeks ago) I had pretty bad hemorraging (sp?) right after I delivered him and also a fourth degree tear. I was wondering what a midwife would do in a homebirth situation if this were to happen. My sister is considering a home birth and frankly so am I for my next one but we are facing some opposition from our families. "Hospitals are the safest place to give birth", "You could have died", etc. But I don't want to dismiss their concerns because I know they have our best interest in mind. So how would a midwife typically handle a case like that?

[Maximeee]

Well, my MW carries Pitocin in case of PPH. I'malso taking supplements to decrease the chance of PPH. And with a MW you are less likely to tear (more natural pushing etc).

[lil_earthmomma]

I had pph and it was easily without alarm, panic or drama of any sort taken care of with a shot of pitocin in the leg. Actually, they giggled at me when I wailed in a weak voice "I don't want a needle!!!" They kindly and gently reminded me that I just pushed for 3 hrs, this would be nothing.

A competent mw can deal with pph as well as stiching up tears. My mw also carry oxygen, ivs, intabation equipment, etc. and have more gear than my paramedic husband is given on oil rig sites.

[wild fire child]

My midwife is comfortable handling small tears, but any that are really big or require weird stitching she will transfer to the hospital (rather, give the mother the choice of transfer). She carries numbing and suturing supplies of course, but she looks at it like the way you heal is what you're going to be living with for the rest of your life, so if she feels not quite competent she will reccommend transfer. And of course, with being completely in control of your birth, not pushing until your body is telling YOU you're ready, going slow to ease a stretch, and the option of water birth which takes off a huge amount of that strain, you're much less likely to tear than at a hospital, plus you won't wind up with a forced episiotomy that may lead to even more tearing on top of the epi.

She carries pitocin for hemorrhaging, but again if it seems out of control she will transfer us. The hospital will admit only the mother, get things dealt with, never have anything to do with the baby as it is not their pattient, so I'm comfortable with that if it needs to happen.

I'd really recommend reading lots of birth stories, even if you're just toying with the idea of a homebirth they can show you exactly how women or their MWs have dealt with any problems that have arisen with their births.

[foogoomomma]

Originally Posted by Maximeee

Well, my MW carries Pitocin in case of PPH. I'malso taking supplements to decrease the chance of PPH. And with a MW you are less likely to tear (more natural pushing etc).

Yeah that I can't believe the difference in care from a reg. obgyn to a midwife. I would recommend beginning care with a midwife as soon as possible in pregnancy. I can only wish that I had started sooner with mine. Even just the vitamins I'm taking have made a huge difference in how I feel. She monitors me closely and really takes the time to talk to me about things. I feel like she's actually getting to know me and guess what -- she remembers me! I remember going to reg ob appts and they would spend half the time reading off the chart because they had no clue who I was.

What I'm saying is they monitor you so closely throughout your pregnancy to make sure that your body is ready.. that you're eating specific foods, that your levels are where they need to be, etc. I was very anemic and had no clue coming from my ob just how bad it was. I had told them how tired I felt, but not once did they do a simple finger prick to check me. My midwife immediately found out and wow what a difference just taking floradix, really good prenatals, and other supplements have made. Had I stuck with my ob I don't know what would have happened I probably could have hemorrhaged as well! With a midwife it's more than that too. It's .. what have you been eating? Are you eating out a lot? Are you drinking water.. how many ozs? Mine is so concerned about me and really spends time with me. It's like having a mother or grandmother that is actually caring for you and watching out for you and baby. She also is trained and has herbs and pitocin and oxygen among many other things. She knows when to transfer if necessary too.

I just can't rave enough about the difference in quality of care. My first visit with her was nearly 2 hours! 2 hours with a ob? Yeah right. Most of my visits are about an hour or more now and all of my questions are answered. I never feel rushed and she actually brings up things that I hadn't thought about. I have a lot of kiddos and forget to take care of myself sometimes and she's there to remind me to do that. All in preparation for a good and safe birth.

Your history is even more important. Having a midwife armed with that knowledge she will work with you to do all the possible preventative measures that you can. For tearing we'll be using warm compresses with olive oil if I have an out of water birth. They help provide support to that area and will help guide you through pushing too.. as in ok go a little slower now and give the skin some time to stretch a bit.. things like that. No more ok let's hold your legs to your ears while you push! It's how do you feel comfortable pushing? On your knees? On a birthing stool or in water? There are just so many more options. You are free to birth as you wish.

[janasmama]

you may want to ask this question in the 'Birth Professionals' forum for more qualified answers.

I don't think that there is one answer to your question b/c different mw's do different things.

But in general, post partum hem. can usually be managed at home. I know that my midwife has handled at least 3 of them and she hasn't had to transfer for any of them and the mom and baby were healthy when she left.

[MsBlack]

Yes, I would take this to the Birth Profs forum.

In brief, often the pp hemorrhage and especially 4th degree tears are caused by the common procedures/practices of hospital birth. I've never had to transport for pp hem, and have seen only a few of them to begin with. I don't carry pitocin--used natural measures to help control bleeding. Never seen a 3rd or 4th degree tear, even very few 2nd degree, and only a couple of those required suturing. I also just saw a thread on a mw forum elsewhere--and a mw who has done more than 2500 homebirths said she had only seen a total of 3 tears that were 3rd/4th degree.

For women who are reasonably healthy and carrying normally healthy babies, there is absolutely no evidence that the hospital is a safer place to birth. While some homebirth moms do transfer to med care from home, most of those do so for non-emergency reasons (exhaustion, pain relief). Read the British Med Journal's article on the 'CPM 2000 study', this will provide info to share w/family about the safety of homebirth.

[ann_of_loxley]

I'malso taking supplements to decrease the chance of PPH.

What would that be?

[barefootpoetry]

My HB MWs are waaaaaaayyyyy more proactive about PPH than the CPs at my last birth. I've been drinking RRL/nettle tea since the beginning of my pregnancy, and taking alfalfa and Floridix to boost my iron so if I do lose blood I recover easier. They carry Pitocin, Cytotec, and another drug whose name I forget to control bad PPH, but those are a last resort: first they would get baby nursing and possibly have me eat a piece of placenta before they got out the needle. If the bleeding didn't get under control within a certain amount of time, we'd go to the hospital.

Not to mention that in general, hemorrage is less likely at a homebirth because the overall environment and birth process is gentler and not as frightening as a hospital can be. Oxytocin abounds and clamps down the uterus, whereas in a scary hospital situation adrenaline would shut off the oxytocin and make the blood flow much faster.

They can suture small tears, but anything large that goes through lots of layers of tissue would have to be handled by a surgeon because that is beyond their realm of expertise. If that were to happen, they'd wait till both baby and I were settled down after the birth, let baby have a good long nurse and fall asleep, then they would take me to the hospital while DH stayed behind with the baby, I'd go in and get sewed up, and be discharged before my baby likely even knew I was gone.

Tears are also less likely at a HB because I would not be coached pushing on my back over a dry, taut perineum. Better positions, as well as pushing in the water at my own pace, make the skin much more supple and easier to stretch over baby's head.

[mrforbes]

My midwife could have handled that. She carries quite an array of equipment and supplies for situations like that. That said, if she felt mom and baby would be better begin seen in a hospital, she would say that - it would depend on mom and baby. I had some bleeding issues and she was really great about evulating me and what would be the best option for us - for us, it was staying at home.

[chantald]

My MW also carries Pit and would give it, along with herbal and homeopathic remedies for blood loss.

For a 4th degree tear, she would transfer me to the hospital to get stitched up. I knew that going in, she stated she could do anything up to a 3rd degree. Thankfully I only had a 1st degree. I did need the pit shot, but it wasn't a "life threatening" blood loss situation

[taramommy]

I believe the other drug someone mentioned would be methergine. I had PPH with my first birth and received this. I am going to ask my hb CNM also to bring Cytotec to my birth because of this history. I understand that used rectally it is quite effective at controlling PPH and is being distrubuted by WHO in undeveloped countries for this purpose.

[Pyrodjm]

She would have given me pitocin and stiched me up. I was very concerned about pph and also suplemented w/ alfalfa and RRLT to avoid it. I specifically asked how she would deal with hemorraging she was completely confident while explaining what would be done.

[blissful_maia]

Pitocin wouldn't likely have helped, as your hemorrhage was probably due to your serious tear (not from a poorly-contracted uterus). If this happened to me at a home birth, I would give oxytocin so to at least control any potential uterine bleeding, clamp off any obvious bleeding vessels, start an IV and transfer to the hospital where an OB could suture under anaesthesia. I don't think there are many midwives who would repair a 4th degree tear at home (at least I hope not), though they are so, so, SO unlikely to happen in a birthing woman-led home birth.