[OMama]

During my first birth I hemorrhaged a bit after delivering the placenta. Not excessively so, but it was still classified as a hemorrhage. They gave me pitcoin and then immediately methregen (or something like that) to stop the bleeding. That seemed to work.

This time I am planning a homebirth and have been told that just because it happened the first time that it won't necessarily happen again, but that we should still be prepared. My two midwives have suggested 'active management' which I have come to understand means that after the baby is out but before the placenta is delivered that they will give me a shot of pitocin to try to prevent the excess bleeding from happening. I would prefer to not have any drugs but they also told me that if the pitocin doesn't stop it and if the methregen (which again would be the next step) doesn't stop it, that they would then give me cytotec (which I am fearful of!) or of course I would have to be rushed to the hospital. (Is stopping bleeding what cytotec is designed to do? I know I would never accept it for induction, but what is the purpose of this drug supposed to be?)

So, do I decide to go with this "preventative" course of action or active management or do I just deliver the placenta and then see what happens? And last time the placenta was not "pulled" nor did anything else out of the ordinary seem to happen.

Anyone have any experience with "active management" or anything else to do with hemorrhaging after birth? What else could I do to stop bleeding in advance -- drink lots and lots of RRL tea?

 

[maxmama]

Quote:

Originally Posted by OMama During my first birth I hemorrhaged a bit after delivering the placenta. Not excessively so, but it was still classified as a hemorrhage. They gave me pitcoin and then immediately methregen (or something like that) to stop the bleeding. That seemed to work. This time I am planning a homebirth and have been told that just because it happened the first time that it won't necessarily happen again, but that we should still be prepared. My two midwives have suggested 'active management' which I have come to understand means that after the baby is out but before the placenta is delivered that they will give me a shot of pitocin to try to prevent the excess bleeding from happening. I would prefer to not have any drugs but they also told me that if the pitocin doesn't stop it and if the methregen (which again would be the next step) doesn't stop it, that they would then give me cytotec (which I am fearful of!) or of course I would have to be rushed to the hospital. (Is stopping bleeding what cytotec is designed to do? I know I would never accept it for induction, but what is the purpose of this drug supposed to be?) So, do I decide to go with this "preventative" course of action or active management or do I just deliver the placenta and then see what happens? And last time the placenta was not "pulled" nor did anything else out of the ordinary seem to happen. Anyone have any experience with "active management" or anything else to do with hemorrhaging after birth? What else could I do to stop bleeding in advance -- drink lots and lots of RRL tea?

Misoprostol (cytotec) is an ulcer medication, but it does work like a charm to stop a PP bleed. We use it as our first line treatment, because it doesn't have to be injected (it's pills that go in your bum) and it works much better than pit and methergine.

Active management of third stage is pretty controversial. It has been shown to reduce the incidence of PPH, but that's not terribly high in an unstressed (e.g., no long induction) uterus, though it can happen, and a history of PPH is a risk factor for having it again.

Cytotec isn't the boogeyman; it's a tool, and it works very, very well for PPH, without the BP risks of methergine. Rather than risk a hospital trip, I would probably go for the active management and cytotec if needed.