"Active Monitoring" because of pph risk - Mothering Forums

 
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#1 of 14 Old 03-16-2007, 02:11 PM - Thread Starter
 
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So I was talking to my midwife today, whom I love and trust and who is so NOT a "medwife", about my desire to have as little monitoring as possible at my first homebirth. I've had 2 previous births at the hospital, one with an OB and with a midwife.

Both previous births I had a pph.

The last time was the worst; my hemoglobin went down to 69 and I ended up rehospitalized.

Anyway, apparently there is an increased risk of this happening again. My midwife practices within a group and said that some of the group might want to do increased monitoring and have an IV set up at home during labour.

I hate IVs. You have no idea. I have had horrible experiences with them. Anyway, the IV would be very distracting to me. When I have one, I feel like I cannot use my arm, even though I know intellectually I can. It freaks me out. I hate it. I once even had a nurse accidentally rip one out of my hand while swinging her arm. I refused to have it reinserted, even if I was going to die from the infection and dehydration. You are starting to get the idea.

My point is what good is increased monitoring during labour? How would that help to treat or prevent a pph?
And how does the saline drip help? Is that in case you lose a lot of blood and therefore are at a higher risk of dehydration?

We didn't have time to talk more right then about it. It is open for discussion still. I'm just so disappointed to hear about the increased risk and the potential for increased monitoring. I will spend a good part of my labour worried about what is going to happen when the baby comes out.

:

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#2 of 14 Old 03-16-2007, 02:25 PM
 
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hugs mama! I would say discuss this in depth with your midwife. let her know your past experiences. are there things that happened with your last birth that contributed (maybe with the ob, did he yank on the cord, etc) if so, she needs to know that maybe that is why, not necessarily that you are destined for pph each time. i had some issues with that really worried me , and i talked to my midwife and now feel much better.
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#3 of 14 Old 03-16-2007, 02:29 PM - Thread Starter
 
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Originally Posted by tiffany21074 View Post
hugs mama! I would say discuss this in depth with your midwife. let her know your past experiences. are there things that happened with your last birth that contributed (maybe with the ob, did he yank on the cord, etc) if so, she needs to know that maybe that is why, not necessarily that you are destined for pph each time. i had some issues with that really worried me , and i talked to my midwife and now feel much better.
I can't remember about the OB, but the midwives definitely not. And that was the really bad one. She is going to contact those midwives to see if they remember what happened.

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#4 of 14 Old 03-16-2007, 02:47 PM
 
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it sounds like your midwife may just want you to have IV access & not fluids running the whole time. if you DO bleed, they can hook up fluids right away (instead of fumbling to start an IV) to increase your blood volume which keeps your blood pressure from dropping too low.

are you doing anything preventatively? there's a few threads here about pph with some great advice. i've been taking alfalfa & will have some shephard's purse available.

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#5 of 14 Old 03-16-2007, 02:50 PM
 
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I can't see how more monitoring of the baby during labor would have anything to do with pph - but the IV access would allow for quick administration of fluids if you did hemorrhage. Then there is "active management of the third stage", which in some studies has been shown to reduce the risk of pph, and involves prophylactic pitocin after the baby is born, and getting the placenta out asap.
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#6 of 14 Old 03-16-2007, 02:52 PM - Thread Starter
 
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Originally Posted by doulalove View Post
it sounds like your midwife may just want you to have IV access & not fluids running the whole time. if you DO bleed, they can hook up fluids right away (instead of fumbling to start an IV) to increase your blood volume which keeps your blood pressure from dropping too low.

are you doing anything preventatively? there's a few threads here about pph with some great advice. i've been taking alfalfa & will have some shephard's purse available.

No, not just access. Actually fluids during labour. Not that that part bothers me. It's have it at all. :

I'll have to look into prevention. I'm stocking up on iron for sure. Already hemoglobin at 131, and keeping it high.

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#7 of 14 Old 03-16-2007, 02:56 PM - Thread Starter
 
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Originally Posted by ccohenou View Post
I can't see how more monitoring of the baby during labor would have anything to do with pph - but the IV access would allow for quick administration of fluids if you did hemorrhage. Then there is "active management of the third stage", which in some studies has been shown to reduce the risk of pph, and involves prophylactic pitocin after the baby is born, and getting the placenta out asap.
There is apparently some controversy about the use of pitocin after delivery of baby but before placenta. It apparently is not particularly useful. The pit can be useful after the placenta for an atonic uterus.

One potential cause for the previous hemorrhages might have been extended labours. My uterus may have just had enough by that point. But there is no real way to know, and I may well have a long labour again.

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#8 of 14 Old 03-16-2007, 03:03 PM
 
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Active management of the 3rd stage is clamping of the cord, pit shot, and controlled cord traction. It definitely reduces the severity and chance of PPH in some women.

http://www.aafp.org/afp/20030515/cochrane.html (This is not midwifery based, but a collection of the studies for you to research.)

Whether or not you want your midwife to use this is up to you. Do lots of research about it all. It *is* apparently effective, but not necessary for everyone, from what I've read. In your shoes, I don't know what I would choose.

Can you tell me more about why she'd want an IV in labor? Are you unable to stay hydrated any other way?
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#9 of 14 Old 03-16-2007, 06:29 PM
 
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I have no clue why monitoring would make a difference, unless she's worried about abruption, which still makes no sense.

The IV I can undertsand, sort of. She may want to have an open vein so if you do start to hemorrhage, she can open it wide and give you a bolus, and maybe put some pit in the IV. In the case of a real heavy, fast bleed, someone who is not terribly skilled at starting IV's may have a real hard time finding a vein and lose precious time.
Maybe you could both compromise on a hep-lock, and flush it with saline every few hours to keep it clear?
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#10 of 14 Old 03-17-2007, 11:04 AM
 
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speak to her about this= or them it sounds like she may not be your only attendant. exactly what you have asked us, you could even print out what you have written and use it as a reference when you talk to her--- My guess what she means by increased monitoring is- not necessarily listening to the baby but being sure that you are taking in fluids and emptying your bladder frequently -- at a point in labor I can be a pest like that reminding mom to go to the bathroom about every hour or 2 -- I have just found that for some women a bladder can be full and be slowing decent- being more irritation than a mom realizes and with a low head she may not feel that the bladder is full or that she isn't emptying all the way- then after the birth a full bladder can increase bleeding because the bladder and the uterus are attached and so a plumped out bladder can keep the lower segment from effectively contracting. -- she may mean some degree of active management- like a shot of pitocin after the baby is born and before the placenta -- it is a wives tale that pit cannot be used before the placenta is out- if that were true then there would be no pit inductions- they may want to watch for signs of seperation and then have you get the placenta out asap- when they see that --- I recommend you communicate with them because you want to know what she/they mean.
------------
how much vitamin K do you get in a day? vitamin K foods are mainly greens- cooked gives you more than raw but either will do- most people get about 1/2 of the RDA - so nearly everyone is low in K that alone can have an impact on your bleeding-- the main thing that stops women from hemorrhaging is a well contracted uterus- it does this by being it's own pressure bandage- but our bodies ability to form clots also helps- now we don't want big clots because that keeps the uterus from being clamped down but little micro-clots just like when you have a bloody nose slows down the bleeding and is part of the healing process-- also just like with a bloody nose ice can be used directly on the fundus and the back to help slow the blood flow and reduce hemorrhage.---- in any case even with good iron it may be advisable to supplement with something like liquid chlorophyll to help with vitamin K and some other componets of clotting factors- folate and B12- over the years I have just seen it work- spent quite a bit of time not recommending it and then coming back to it realize that it truly does work to reduce hemorrhage-
what an IV can do if placed before hand is that a vein is not collapsed - and there is some surety of hydration --one of the reasons hydration can be important is it reduces the loss of "rich" blood by thinning it-- also if you are loosing blood it increase volume so your heart is able to still keep beating - veins still plump and helps to prevent DIC- which can buy time for a transport -- in over 20 years I would say that there has only been less than 5 instances where it would have been useful to have an IV- of those 5- IVs were used 2 times,so I am not sure of the usefulness of just a saline lock or IV - if you are taking care of yourself during labor--intake and output really reduces the need for an IV--
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#11 of 14 Old 03-17-2007, 11:51 PM
 
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I realize midwifery varies imensely from place to place but in the 30 years that I've done this, this works for me...First and formost is nutrition as prevously mentioned..lots and lots of vit K rich foods and iron rich as well..Floradix supplement comes to mind and also some kind of green stuff, either a green drink or alfalfa tabs. Injest raspberry leaf tea, 1 qt per day. Shortens labor and sstrengthens uterus besides. Nettle builds blood and can be mixed with rasp leaf. Now comes the controversy...I have NEVER used an iv in a homebirth..and in the event of a bleed, I have used cayenne pepper tincture along with shepherds purse tincture, 1 dropper each in water, drunk fast..It has NEVER failed! I have never used pit. I do not pull on the placenta or fiddle with the fundus.Am I "out there"? Maybe, but this has worked for me..Happy birthing!
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#12 of 14 Old 03-18-2007, 12:10 AM
 
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I had a heplock, but not iv fluids because of my pph risk. How would iv fluids help?

I could have said no, and I will not have one for any future births.

What kind of increased monitoring?

Do you know why you had a pph before?

Do you know the preventative measures you can utilize?

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#13 of 14 Old 03-19-2007, 08:54 PM
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I would ask for a compromise. IV access, but no running fluids without medical necessity. They can saline lock it, cover it up with a soft cloth bandage, and as long as they've properly inserted it you won't even know it is there and will have full range of mobility in the limb
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#14 of 14 Old 03-21-2007, 11:28 AM
 
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Fluids running during birth can cause other complications - swelling of tissues can make birth more difficult, etc.

Does she have access to pitocin, can she administer that in the 3rd stage?

Homeschooling mama to 6 year old DD.

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