fear of pp hemmorhage - Mothering Forums

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#1 of 27 Old 08-29-2007, 05:43 PM - Thread Starter
 
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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?

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#2 of 27 Old 08-29-2007, 05:51 PM
 
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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.

Jenn, wife to John
Mama to Kayleigh (6), Ethan (4), Norah (1), & Charlotte coming 11.09
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#3 of 27 Old 08-29-2007, 05:55 PM - Thread Starter
 
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that would be great, thanks

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#4 of 27 Old 08-29-2007, 07:04 PM
 
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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!!
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#5 of 27 Old 08-29-2007, 07:11 PM - Thread Starter
 
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thanks for your words Angela that may be true about her own fears...

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#6 of 27 Old 08-29-2007, 07:19 PM
 
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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.

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...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.

~BV
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#7 of 27 Old 08-29-2007, 07:28 PM - Thread Starter
 
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.
If I were you I'd look up managerial causes of PPH
I will be looking that up, I appreciate your advice.

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#8 of 27 Old 08-29-2007, 07:29 PM
 
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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.
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#9 of 27 Old 08-29-2007, 10:40 PM
 
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from my gf:

Quote:
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.

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#10 of 27 Old 08-29-2007, 11:50 PM - Thread Starter
 
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thanks Jenn, I printed it up and am going to use it for more research...I really appreciate the time you took

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#11 of 27 Old 08-29-2007, 11:53 PM
 
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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.

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#12 of 27 Old 08-30-2007, 12:06 PM
 
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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.
--LEE
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#13 of 27 Old 08-30-2007, 07:12 PM - Thread Starter
 
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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

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#14 of 27 Old 08-30-2007, 07:37 PM
 
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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.

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#15 of 27 Old 08-30-2007, 08:07 PM - Thread Starter
 
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Originally Posted by mamablueberry View Post
I just want to enjoy the moment of my childs birth rather than worry about bleeding.
.
:

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#16 of 27 Old 08-31-2007, 01:31 AM
 
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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

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#17 of 27 Old 08-31-2007, 01:45 AM
 
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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!

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#18 of 27 Old 08-31-2007, 01:47 AM - Thread Starter
 
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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.

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#19 of 27 Old 08-31-2007, 07:52 AM
 
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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.
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#20 of 27 Old 08-31-2007, 10:29 AM
 
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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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#21 of 27 Old 08-31-2007, 11:22 AM
 
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I forgot until I read the other posts, I also had methergen (sp?) after both births. I guess it was 4-6 pills? 1-2 days worth? Again, no big deal.
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#22 of 27 Old 08-31-2007, 11:47 AM
 
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Originally Posted by NZmumof2 View Post
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.
That sounds like the Bristol trials. They were seriously flawed. The Huntingdon studies completely refuted them.

Pitocin does not stop bleeding. In a non-exhausted uterus it can induce contractions which will clamp down the uterus squeezing shut blood vessels. It an exhausted uterus it will not stop bleeding and some report it contributing to PPH.

Cord traction can lead to a partial abruption *increasing* risk of PPH. Many took the results of the Bristol trials as proof cord traction prevents PPH when the reality is it is *far* more likely to cause it.

If you compare the incidence of OOH PPH with in hospital PPH it becomes all the more clear the routine management of labor, birth as well as third stage all contribute to PPH.

Quote:
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.
The truth is most PPH is iatrogenic from labor, birth or PP management. Many of the lifesaving medical protocols only become necessary when lives are endangered by everything that's gone on before. I recommend reading Henci Goer's Obstetric Myths Vs. Research Realities to get a handle on some of the issues.

Quote:
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.
My issue is the MW demanded non-negotiable interventions *regardless* of health situation at the time of birth *without* discussing interventions they can avoid which contribute to the problem. IMO that is cookie cutter, assembly line medicine *not* considering the needs of the individual. Even an IV with just saline can mess with blood sugar levels leading to exhaustion, the "need" for augmentation & pharmaceutical pain relief, and uterine exhaustion with ensuing PPH unresponsive to Pitocin. IMO *if* the MW were to treat this client responsibly and respectfully she would have discussed the causes of PPH, ways to avoid the causes, and then options for treating it in reality as well as prophylactically.

BV, always advocating informed consent
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#23 of 27 Old 08-31-2007, 05:15 PM
 
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That sounds like the Bristol trials. They were seriously flawed. The Huntingdon studies completely refuted them.

Pitocin does not stop bleeding. In a non-exhausted uterus it can induce contractions which will clamp down the uterus squeezing shut blood vessels. It an exhausted uterus it will not stop bleeding and some report it contributing to PPH.

Cord traction can lead to a partial abruption *increasing* risk of PPH. Many took the results of the Bristol trials as proof cord traction prevents PPH when the reality is it is *far* more likely to cause it.

If you compare the incidence of OOH PPH with in hospital PPH it becomes all the more clear the routine management of labor, birth as well as third stage all contribute to PPH.



The truth is most PPH is iatrogenic from labor, birth or PP management. Many of the lifesaving medical protocols only become necessary when lives are endangered by everything that's gone on before. I recommend reading Henci Goer's Obstetric Myths Vs. Research Realities to get a handle on some of the issues.



My issue is the MW demanded non-negotiable interventions *regardless* of health situation at the time of birth *without* discussing interventions they can avoid which contribute to the problem. IMO that is cookie cutter, assembly line medicine *not* considering the needs of the individual. Even an IV with just saline can mess with blood sugar levels leading to exhaustion, the "need" for augmentation & pharmaceutical pain relief, and uterine exhaustion with ensuing PPH unresponsive to Pitocin. IMO *if* the MW were to treat this client responsibly and respectfully she would have discussed the causes of PPH, ways to avoid the causes, and then options for treating it in reality as well as prophylactically.

BV, always advocating informed consent




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#24 of 27 Old 09-01-2007, 06:50 AM
 
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Bryony do have a link to the Huntingdon trials you mentioned? I have searched for them and the closest seems to be a Hinchingbrooke trial that was designed to discover if PPH was actually an issue in healthy women in a hospital setting and to have midwives actually experienced with active management and expectant management involved to decrease bias as in the Bristol trials. The rate of PPH was still reduced by 2.4 times by active management.

I have gone and reviewed the World Health Organisation statements and done a Medline search but all the studies I find still support the reduction in PPH from active management.
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#25 of 27 Old 09-02-2007, 12:36 AM
 
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just throwing out this article, by Dr. Sarah J. Buckley:

http://www.bellybelly.com.au/article...oach-to-labour

plenty of study citations throughout.

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#26 of 27 Old 09-02-2007, 09:04 AM
 
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Bryony do have a link to the Huntingdon trials you mentioned? I have searched for them and the closest seems to be a Hinchingbrooke trial that was designed to discover if PPH was actually an issue in healthy women in a hospital setting and to have midwives actually experienced with active management and expectant management involved to decrease bias as in the Bristol trials. The rate of PPH was still reduced by 2.4 times by active management.

I have gone and reviewed the World Health Organisation statements and done a Medline search but all the studies I find still support the reduction in PPH from active management.
Darn it! Those sites I've always used for free articles now only show the abstracts for free. :

I did find one cause of confusion though. We are talking about the same thing. Hinchingbrooke is the name of the only hospital in the small town of Huntingdon.

IIRC (can't access those darn studies) there was a small reduction in *average blood volume lost* in the aggressive management group (Pit + cord traction) *but* the aggressive management group had significantly more cases of actual PPH. In order for these averages to jibe many women would have to have their blood loss reduced in order to still have the average loss slightly lower while including all the cases of PPH.

I'd rather wait and trust all women to deliver on their own and only respond when I see a problem developing, than to intervene on everyone and *cause* PPH, a potentially life threatening condition. At my first birth I was one of those women who had *induced* PPH, lost 40% of my blood, and nearly died as a result. Seven times since I've had a completely hands off third stage and, while I still bleed before the placenta births, would never consider it true PPH let alone life threatening.

My believing what I see could be so different than your believing what you see because I've been mostly at OOH process trusting births. Our local hospital has a 92% epidural rate (which could be why NCB advocates birth OOH!) and it wouldn't surprise me if they feel they *need* drugs to prevent problems in 3rd stage because all the physiologically unnatural things done/given up to that point interfere with a normal and safe 3rd stage.

~BV
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#27 of 27 Old 09-04-2007, 05:57 AM
 
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Bother just wrote a long reply but my login timed out and I lost it!

I attend births in a small rural maternity unit, no epidurals no continuous monitoring, labour and birth in any position, spa and shower most frequently used analgesics, although gas and pethidine are options if women request them (less than 50% have either). I've performed 2 episiotomies in 100 births there, both for fetal distress. Sutured around 10 times.

Exclusive breastfeeding is encouraged, formula treated as a prescription med and used hardly ever, unless women are adamant they won't breastfeed but pretty well every woman exclusively breastfeeds at least the first few days most for much longer.

It's a very pleasant place to welcome babies into the world and vastly different from the larger hospital we refer to where I notice that women I have referred for specialist care for various reasons are being offered an epidural at 3cm when they are subsequently induced - the c-section rate there is 25% and rising as fast as the epidural rate to my frustration.

I absolutely support OOH birth although I don't attend them because I can't combine that kind of workload with my family practice, I would have had my babies at home only I needed a GA c-section and ICU for PET / HELLP so that choice became a little impractical! At the least I am aiming to be conscious when this baby arrives and hopefully an intervention free vaginal birth!
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