Post-partum hemorrage experiences? - Mothering Forums
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#1 of 29 Old 04-26-2013, 11:20 AM - Thread Starter
 
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I am sorry if this brings up dark memories. Please, don't read my post if you have yet to heal from a scary experience-- I don't want to reopen any wounds, but i have questions the books aren't answering.

--

I have a few risk factors which my caregiver has informed me put me at higher risk of post-partum hemorrage.

I want to be mentally prepared for what interventions to treat that are like from the point of view of keeping baby skin to skin and those other more personal things that are important to me. I have a lot of information from a technical perspective.

Is anyone willing to share how they dealt with this at your birth? Were you able to hold your child during uterine massage or while pitocin or other drugs were administered? Did you need a blood transfusion?

How did your partner handle it? If you weren't able to hold your baby, was he? Or did you prefer to keep him close by is possible?

Sorry if this brings back dark memories.

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#2 of 29 Old 04-26-2013, 06:10 PM
 
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I had a risk factor that made this a potential in one of my pregnancies, and sure enough it happened. I wasn't scared, though I did end up needing a transfusion. I think my number (can't remember what it was but they test you to see if you need a transfusion) was not far over the line where I had to have one, so it could have been worse I am sure.

For obvious reasons, this is all a bit fuzzy. I was able to hold my baby most of the time, though I remember one period of time where I passed her off to her dad because I was feeling woozy. I was given a few different kinds of drugs, but again I was woozy and don't remember specifics. I know pitocin was one but I remember being given quite a few pills too. The drugs made me sick to my stomach. I do remember that. But the bleeding did stop and everything was fine after that. I didn't have to stay in the hospital for any extra time.

My husband said he was scared but I was a bit out of it and don't remember being scared at all. I felt like they (the midwife and hospital staff) were prepared, knew what to do, and handled it well. I remember feeling confident that they'd take care of it. It didn't feel that serious to me, and I think that was because of how prepared and confident the hospital staff seemed. It was like they'd dealt with it a number of times and knew just what to do.

I was much more tired for the weeks after this birth than my first birth, and I have to imagine that this is why. Actually, it might have been a couple of months or so of extreme fatigue. I had absolutely no energy. And I had a huge breastmilk oversupply with the first baby, but my supply was just the right amount with the second one. I suppose the hemorrhage could be why I had a lower supply. For me, the lower supply was a good thing, but I can see how it would be a problem in other circumstances.

Enlist help for after the baby is there, really concentrate on getting the baby to the breast as much as you can those first few days, and know that this isn't the least common risk issue there is and your provider has probably dealt with it a number of times. At the hospital I was at, if the problem is too great, the doctor takes over, and my midwife stayed in charge the whole time, so it must never have gotten to that point. Try to relax and enjoy your pregnancy. <3

Feel free to PM me at any point if you want to talk about this more.
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#3 of 29 Old 04-26-2013, 08:09 PM
 
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I had a homebirth, but after reading MamaZee's post, I was surprised by all the similarities between hemorrhage experiences despite the different circumstances. I was just on the edge of needing to receive pitocin and a transfer. Getting the placenta out through uterine massage and perhaps drinking the anti-hemorrhage herbal tea I'd made the night before seemed to slow the bleeding. We got the baby to latch on right away, which can help with hemorrhage, I've read. Also, I had used hypnosis for my birth and there is actually a hypnosis cue to slow bleeding, which I used on myself. Hard to know if that helped.

 

I had a very peaceful, ideal birth and the hemorrhage was a surprise to me and to everyone present, including the midwives. But I had complete confidence in the midwives caring for me and wasn't even slightly worried. I was pretty out-of-it, though. My husband, who has experience as a medical caregiver, looked terrified at one point when the first steps taken did not stop the bleeding--it got worse before it got better.

 

I don't really remember the order of things, but I remember that once the bleeding was under control, I could not even elevate my head slightly without starting to pass out for some hours. I also had to have a urinary catheter. The midwives suggested I transfer to the hospital, but I rejected this. (In retrospect, maybe it would have been better, but I feared they might separate the baby from me, or that I or the baby might get some hospital bug.) The baby stayed very close to me for most of the whole ordeal, except maybe when I was on the verge of fainting.

 

Like MamaZee, I was not in great shape for the first few weeks after the birth. (I had other factors complicating this, like PPD and severe sleep deprivation-related exhaustion even prior to starting labor.) I barely left my bed, and my husband did everything for the baby and me except breastfeed. Breastfeeding was extremely hard (very, very painful for about 6 weeks despite lactation consultants and not certain I had enough because the baby was growing slowly, etc.) I was physically weak for quite a while after birth, a couple of months maybe, and then started to improve.

 

The hemorrhage itself wasn't really traumatic, actually. But the aftereffects made our family's new life together more difficult at first.



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#4 of 29 Old 04-27-2013, 10:25 PM
 
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I hemorrhaged with zero risk factors. The nurses hadn't gotten a chance to place a line, which was unfortunate. I was holding my baby nonstop through the whole process. The hemorrhage started after the birth of the placenta. Uterine massage hurt like f!ck and didn't do the trick, an IV was placed with difficulty, and while that was going on I got rectal cytotec. I got IV pitocin once that was possible and another round or two of vigorous uterine massage. I was kind of out of it but had a good hold on the baby, and holding him helped me keep my head on straight, I think. No transfusion needed.

My husband had a good game face on (he's a doctor, they are good at looking unruffled no matter what), but he later admitted that he was very, very scared, especially when they couldn't get a line started at first. He said my midwife and the nurses worked so calmly, quickly and competently that he knew after a minute things would be ok. He was right next to me the whole time. I think all in all he handled it well, but he is now dead set against ever having a home birth, which I can't really blame him for but makes me a little sad all the same. However, my son's hospital birth was everything I hoped it would be, so that's reassuring for future births smile.gif

It's good you know you're at risk for hemorrhage- if it doesn't happen, wonderful, but if it does, at least you can mentally prepare yourself. A lot of women are very shocked by how rough the third stage can be.

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#5 of 29 Old 04-28-2013, 05:11 AM - Thread Starter
 
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Thank you for sharing ladies! joy.gifI was really comforted by how confident you each were in your care and what a difference that made. Thank you especially for your frankness. I know that a lot of people think birth would be better if we didn't know about what could go wrong (think positive to get positivity in your life... etc) but I tried that, and still ended up with complications beyond my control.

 

It's a shock to go from identifying as young, healthy, and vibrant to knowing your frailty and vulnerability, but I feel more empowered now than before. I am finding that being educated about risks, being proactive about preventative measures, and knowing common interventions has helped more than any abstract positive thinking could, though it is hard to know the scary possibilities. redface.gif

 

Most of all though, I was glad to see that if I feel well, this isn't the sort of thing that will necessarily interrupt skin to skin time, but I can definitely see that if I feel woozy, it's best for everyone for dad to take over baby-care until the worst passes. This is my biggest worry. I feel so mama-bear protective of that early bonding time!!

 

Mamazee:

 

Thanks for the tip about enlisting help! My mom is planning to visit for the week before my due date and to hang around for at least a week after she is born in order to help us get going. I feel really blessed to have that option, and to know that after that, my MIL would happily step in if I still need help. 

 

sky_and_lavender: 

 

I am interested in the tea, latching, and hypnosis options as much as I am in the medical stuff, so thanks for bringing that up! Latching is why is was so worried about them taking baby away during interventions, and I think something like hypnosis would at the VERY least comfort me, and I do believe that the mind-body connection matters, so I'd be willing to try it. I don't know anything about teas though, other than that I decided to go for the raspberry leaf blend at a local herbery because of anecdotal evidence, and the fact that it's very tasty. :) 

 

Kate:

 

I too was really bummed about not getting my first choice of birthing scenarios, but I am glad you feel good about it in the end! I hope I do too. Thanks also for sharing the treatments they used so I can have a better idea of what to expect. 

 

Really,Thanks everyone, again. grouphug.gif

 

I was worried no one would reply, or that it would be too negative a topic. 

 

Update on my story: 

 

I went on a hospital tour this weekend, heard from some people who've birthed there and with my OB, and I think the practice we ended up at is pretty progressive and compassionate. I hope I am able to leave it feeling confident and satisfied with my care like you did! It's way friendlier than I thought a hospital could be. For anyone who is in Colorado, I'm referring to Swedish Medical Center and Dr. Micheal Hall. I met a doula who's attended 5 of his births and said he was warm, competent, and really respectful of natural birth wishes. I think his wife is a homebirth midwife! 

 

I am worried about my husband though. He is not at all steely-faced, and I am worried that if he is my rock this whole time, but then falls apart then I will too! I will share these stories with him in the hopes that they give him confidence that it's a common enough complication that practicioners have a good handle on it. 


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#6 of 29 Old 04-29-2013, 11:49 PM
 
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"I was really comforted by how confident you each were in your care and what a difference that made."

That's the thing, I knew my midwife (CNM). I trusted her to keep her hands off as long as things were normal, I trusted her to recognize abnormal, and to manage abnormals appropriately while supporting the normal stuff. For me as a CNM myself, this was a huge relief. I did not make big management decisions myself, in the moment. I was able to focus on my baby while the pros sprang into action where before they had melted into the background. Sounds like you have a similar setup. Enjoy your birth and congrats in advance in your wee one! Update the thread, please? smile.gif

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#7 of 29 Old 04-30-2013, 02:41 PM
 
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I expected PP hemorrhage - my mom had a transfusion with my birth, and I was carrying twins.  So for the weeks going into my birth i made sure to keep healthy, get my iron and fluid level high, and took alfalfa supplements.

 

This is at home: my MW estimated that I lost about 1500 cc of blood, maybe not officially a hemorrhage, but significant.  It came so fast it sounded like my bladder emptying.  Fortunately, I didn't see much of it.  I was hooked up to an IV for fluids, and when making it from the birth stool to the bed I started to faint.  But I rested in bed, passed a few clots, lots of uterine massage and nursing, and I was good.  Took it very easy after birth, not leaving our second floor for the first days, and not the house for another few.  But I was back to normal quickly. 

 

My secret to success was always having a glass of very watery OJ at hand, with a straw. 

 

Sorry I don't remember more detail.  But planning ahead and expecting some blood loss will help.

 

Best wishes!


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#8 of 29 Old 05-01-2013, 09:45 AM
 
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Yep, though not in a hospital.  I had pretty low platelets, so my midwife was prepared.  She gave me a shot of methergine and that seemed to do the trick.  However, we are guessing that between that and my son's lackluster latch, my supply suffered quite a bit.  I did actually pass out when it was time to take that first trip to the bathroom, but once I was able to get back to bed and eat/drink I felt much better and didn't need any intervention.  I really should have hydrated way more than I did though.  DS was born at 8 PM at night and it was so easy just to sleep the whole night instead of doing other things like drinking coconut water.  ;)

 

Since then we've found that low-ish platelets are standard for me for an unknown reason and not a symptom of pregnancy and are once again watching it closely.  This time around I'm doing the RRL tea and trying to eat things that are good for the blood.  Hopefully DD's latch will be more stellar and we can get her to help too.  I definitely have the benefit of hindsight now.


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#9 of 29 Old 05-01-2013, 01:10 PM - Thread Starter
 
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GISDiva-- low blood platelets are one of my risk factors, it's not pregnncy related for me either- my normal doc found it during a check-up.

I was recommended sesame seed oil (2tbs a day), but I didn't find any evidence for that so I gave it up after a month or so when I saw no change in my labs. I am trying RRL also, and at least that makes for a tasty iced tea, even if it doesn't help in the end.

I've heard from my normal doc, OB, and the midwives I was seeing before risking out that most of the time, no one can figure out low platelets, and since the only treatments are steroids, they avoid it as long as your platelets don't plummet (in pregnancy or otherwise).

Obviously, a healthy diet never hurts, but they all said they've never seen platelets respond to dietary changes since it's not usually caused by deficiency.

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Do you know what your platelet count was? Just curious. smile.gif

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#11 of 29 Old 05-02-2013, 10:19 AM - Thread Starter
 
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Katie-- not sure who you are asking, but mine was 120 (+- 15-20) before pregnancy, and dipped below 100 at my last draw. 100 was the risk-out threshold my midwifery practice had decided on, which is why I switched to a hospital birth. In addition to that though, I have anatomical reasons to suspect more bleeding, which is why I didnt hesistate to transfer.

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#12 of 29 Old 05-02-2013, 11:08 AM
 
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I have another test coming up in a few weeks, I think, so I don't know what I'm at right now.  Pre-pregnancy it was 117, first test after pregnancy started it actually jumped up to 129.  (Hopefully that's not a cause for false hope.)

 

I don't recall the exact numbers from my son, it was five hears ago.  I think they got as low as 75 at the very, very end.  The perinatologist that I saw for another (bogus) issue mentioned I probably couldn't get an epidural because of it.  He didn't know I was planning an out-of-hospital birth.  Sheepish.gif

 

The weird thing is that everyone in my DDC is complaining about bleeding noses and gums and I have none of that.  You would think I would.  


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#13 of 29 Old 05-02-2013, 11:21 AM - Thread Starter
 
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Yeah-- I have no nose bleeds, but my gums *just* started bleeding a tiny bit. I think that has more to do with vascular thinning though, which is hormonal.

I do have lots of bruising though. As always.

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Wow, those are some low platelets alright! Isn't it amazing what our bodies can adjust to? There are women walking around with hemoglobins of 9 who don't notice a thing. Not that that's healthy, just saying, it's impressive.


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#15 of 29 Old 05-02-2013, 01:22 PM
 
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Originally Posted by cynthiamoon View Post

I do have lots of bruising though. As always.

 

I'm not even sure I have that.  I don't really know what to compare it to.  I have really fair skin too, so the same bruise on my part-Sicilian husband would look a bit different on me, you know?   I don't know what to think of the whole thing really, and neither does anyone else...


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#16 of 29 Old 05-04-2013, 11:02 PM
 
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Not what you asked about, but I wanted to add that you may want to consider placenta encapsulation to help you recover after the birth, particularly if you're facing the possibility of greater-than-usual blood loss.


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#17 of 29 Old 05-04-2013, 11:12 PM - Thread Starter
 
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Not what you asked about, but I wanted to add that you may want to consider placenta encapsulation to help you recover after the birth, particularly if you're facing the possibility of greater-than-usual blood loss.

 

I definitely have thought about it, but we haven't made any moves to hire someone yet. I was initially interested because of the supposed hormonal benefits, but this is an interesting point I had not considered! 


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#18 of 29 Old 05-13-2013, 07:00 PM
 
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Wow, those are some low platelets alright! Isn't it amazing what our bodies can adjust to? There are women walking around with hemoglobins of 9 who don't notice a thing. Not that that's healthy, just saying, it's impressive.

Pardon me while I stick my nose into everyone else's business here, but I don't really think these platelet levels are that bad.  Mine were only 35 when we first tested, they dropped down to 20 the next time, and then up to 110 when I gave birth.  I gave birth in a birth center with a CNM, and I did hemorrhage.  I wasn't panicked, but everyone else was, and it has turned my mom against non-hospital non-OB birthing.  I wasn't panicked because I didn't know what was going on, as nobody let on what was happening and I was too wrapped up in my son to noticed what they were doing to me.  I do remember them giving me a shot of pit and vit K and the next day I got another shot of K and methergine pills.  I had no one to help out postpartum and I was in baaaddd shape.  Sooo tired and weak.  I stayed 2 days at the birth center, which they NEVER do (normally you are in and out).  Despite all of this, I have good memories of the birth and if I ever have another, I will go the same route, but will prepare more first with alfalfa/rrl/nettle teas, plant sterols (which in one study showed the best outcome of alternative treatments when compared to steroids), nipple stimulation after birth if baby is not latching, etc.  I've actually been reading everything I can find on it, and find midwifertoday.com articles and newsletters to be the best.


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#19 of 29 Old 05-13-2013, 07:34 PM
 
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Which platelet levels do you think weren't that bad? You hemorrhaged severely with platelet levels of 110 and this woman has levels below that.

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#20 of 29 Old 05-14-2013, 09:34 PM
 
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On platelet levels, the local birth center will still do a birth in the center with platelets at 75. My cut off is 100...
Something to mention that is in the hemotology textbooks is folate . Low platelets can occur from low folate and it doesnt even have to be testing low to effect platelets can be still within normal range- a few women I have seen have successfully altered their platelet levels by taking sublingual high doses of folate, there was on gal it did nothing for so it is a consideration it may or may not work.

Oh and I wanted to mention that physical examination can help to determine what might be going on, usually the spleen is hidden behind the ribs, if you can with light palpation feel the spleen then mom is probably a candidate for meds.
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#21 of 29 Old 05-14-2013, 09:41 PM - Thread Starter
 
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I wonder if folate in prenatals is why some women with ITP experience a rise during pregnancy rather than a drop?

I did try tablet folate last Jan/Feb and didn't see a difference in my own counts though.

I also stopped drinking (back then, and obviously again now) because I read alcoholics get thrombocytopenia and I became weirdly paranoid that I was somehow drunk more often than I realized. That didn't do anything either, except make me realize I am definitely not an alcoholic.

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#22 of 29 Old 05-15-2013, 01:24 AM
 
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So there is also a potential for gluten intolerance to effect the spleen and platelets, it would be something to rule out. Infact any one with a problem that may be autoimmune in origin could also have gluten intolerance.
My father has psoriasis, and that lowers his folate by increased utilization...
Pregnancy is a healthy increase in utilization, for mom and baby... Blood volume expansion and baby growth. Thyroid function can alter absorption in the small intestine...
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#23 of 29 Old 05-15-2013, 08:35 AM - Thread Starter
 
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Gluten issues and low blood platelets are only linked in combination with other diseases, like Celiac and leaky gut (which needs a new name... jesus.) People without those digestive issues have not been found to benefit from gluten-free diets. 

 

"Celiac disease, an autoimmune disease of the small bowel caused by a cross-reaction to the gluten in wheat, barley, rye, and similar grains, has been linked to low platelets (Hatting 2010,  Halfdanarson 2006).  In gluten sensitivity, a different problem, the ingested gluten, along with other triggers, breaks down the wall of the intestines and increases the possibility of particles passing directly into the blood stream, leaky-gut syndrome.  Leaky-gut syndrome has been linked to autoimmune disease (Visser 2009).  A gluten-free diet allows the intestines to heal and eases the symptoms of both diseases."  http://pdsa.org/treatments/complementary/food-as-a-cure.html

 

I just wanted to clarify this, because the PP makes it seem as if people withOUT Celiac or leaky gut would benefit from a gluten-free diet, and I just don't see any evidence of that. 


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#24 of 29 Old 05-15-2013, 01:55 PM
 
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I see the distinction, since I have had celiacs diagnosed for the last 25 years I really havent kept up with terminology changes /distinctions. I have used the terms interchangably. It is just something to rule out if you have ITP...
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#25 of 29 Old 05-17-2013, 08:58 AM
 
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Oops, sorry I wasn't clear!  I was referring to all of the levels mentioned in the previous posts.  I guess I was just surprised at the level of worry expressed with levels that were all 75+, and I had levels so much lower than that (20, 35).  Maybe I just didn't know enough to be scared.  I didn't feel sick or anything.  I researched thrombocytopenia, but it wasn't anything that made me panic. 

 

I would also say that I didn't hemorrhage "severely," as I didn't require transfer or a transfusion.  It sucked, but it wasn't moribund.


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#26 of 29 Old 05-20-2013, 03:06 PM
 
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Here's my PPH story:

 

I gave birth to both my babies in an out-of-hospital birth center with CNMs.  I had no risk factors for PPH prior to my first birth.

 

DS was born with a nuchal hand and had a tongue tie which made for a bad/nonexistant latch.  I had a "lazy uterus" and lost about 1250ccs of blood, which is the lower end of the definition of "hemorrhage."  They theorized that my uterus was tired from long labor and pushing with the nuchal hand, but my labor was only 15 hours and I only pushed for 40ish minutes.  I think the likelier explanation is that I didn't have great post-birth contractions due to DS's non-latch.  But whatever.  They controlled the hemorrhage at the birth center with an IM shot of pitocin and an IM shot of methergine.  I was also given an angelica tincture orally.  That combined with uterine "massage" took care of it.  I did not have to transfer to the hospital for a transfusion, although I was told if I didn't drink enough, I'd have to transfer for IV fluids.  I was doing well and peeing and all that, so I never did have to transfer.  During the whole thing, I was holding DS skin to skin.  I barely even knew there was a problem.

 

In the days afterwards, I thought I felt awesome from the natural birth.  But having gone through DD's birth with no PPH, I realize that I was extremely weak and sluggish after my first birth.  I took Floradix for extra iron, but I didn't feel like myself again for about 8 weeks.  This seemed pretty normal to me and coincided with breastfeeding getting a lot better, so I thought it was normal.  After having experienced my DD's normal birth, I know it was not.

 

With DDs birth, they told me I was at higher risk for PPH since I had had one with DS.  The CNMs recommended a prophylactic IM shot of pitocin immediately following birth - we discussed this around 30 weeks of pregnancy and my chart was noted for the birth.  I was concerned about the effect of synthetic oxytocin in the immediate post-birth period, but the midwives convinced me that it was likely a drop in the bucket of my natural oxytocin and that the potential benefit of avoiding hospital transfer outweighed the downsides.  DD was born fast and with no complications.  She latched immediately and very well.  My afterpains were SO STRONG that I was convinced that I hadn't had ANY with DS.  They gave me the pitocin shot anyway, but I really think I didn't need it.

 

Like I said, my recovery with DD was hours/days, vs. weeks/months with DS.  I like PP suggestion of enlisting help for the first weeks.
 


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#27 of 29 Old 05-20-2013, 06:20 PM
 
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Just to clarify what we're talking about with PPH, the most common definition is >/=500cc after a vaginal birth, >/=1000cc after a c/s. How a person responds to the blood loss is the most important thing than the number of cc's lost, though, esp since caregivers' estimates are often off. (They tend to underestimate.)


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#28 of 29 Old 05-20-2013, 07:04 PM
 
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Quote:
Originally Posted by Katie8681 View Post

Just to clarify what we're talking about with PPH, the most common definition is >/=500cc after a vaginal birth, >/=1000cc after a c/s. How a person responds to the blood loss is the most important thing than the number of cc's lost, though, esp since caregivers' estimates are often off. (They tend to underestimate.)

Good to know the definition!

 

My midwives weighed the chux pads that I soaked.  That's how they determined the volume.


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#29 of 29 Old 05-20-2013, 08:23 PM
 
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1250 ccs is a pretty big hemorrhage following a vaginal birth! Glad you were ok (although run down) in the end.

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