[DoulaAlicia]

This is a question about me personally and I'm hoping some of you midwives can give some insight. I talk on this forum somewhat frequently but usually about clients or general birth issues.

Well - question about me!

I've had three children. First labor fairly quick - 7 hours after I woke up in the a.m. I had my son.

Next two labors, 2 hrs 45 minutes and 2 hrs 30 minutes respectively.

First two labors no complications.

Third labor I was told in a hospital that I was bleeding too much and eventually given methergine. I still don't know how "emergent" it was.

Questions!! Not pregnant now but researching birth options for #4. I'm considering homebirth and researching precipitous labor and its risks since I had the extra bleeding last time.

I'm seeing that precipitous birth has risks of hemorrhage. Articles stating uterine fatigue after working so quickly and also risks of placenta separating early.

I FEAR my placenta may have separated early last time but I'm not sure. Can you give insight? As soon as I arrived at the hospital (10 cm) I was unbelievably thirsty. More thirsty then I've ever been in my life. I was ofcourse denied water by staff - and I begged and begged - my husband and the nurses and doctors. I didn't get my water. I pushed and it was all I could think of. In between pushing I asked for water again. Baby was out in three contractions and then I drank 7 or so glasses of water.

I've read extreme thirst is a sign of significant blood loss. Do you see this extreme thirst as an indication of early separation of the placenta or something else? What do you think risks are of future homebirth for both myself and baby?

Thanks ladies. I would really love some resources on this if you have any. It is very important for me to get solid info on this subject to set my mind at ease.

 

[DoulaAlicia]

If you would like you can also comment on other scary things I'm reading although I'm assuming they are very rare they are freaking me out.

Such as Precipitous birth makes more likely:

Fetal Head Trauma
Amniotic Fluid Emobolism

 

[Reha]

First of all, about your thirst: it can be a sign of shock from extreme blood loss. If your placenta had abrupted before birth and you'd lost THAT much blood, there would be no question about it. You would have known! And your baby would have shown the ill effects. I don't think the thirst was significant in your case. I've see many women who are suddenly thirsty just before the birth.

I know all the texts and studies say that precipitous birth is associated with PPH. But, I just haven't seen this connection personally. I have seen a few women have a PPH after a very fast birth, but the majority of PPHs that I've seen have been after normal length births.

As to the amniotic fluid embolism, my understanding is that it is nearly nonexistant in labors that have not been induced or augmented with drugs. Not that it can't happen, but it is NOT common enough of an occurance to worry about just because you have fast births.

I have seen bruising sometimes on baby's faces from a very fast birth (also from very long labors). Nothing that doesn't heal fine on its own.

Its hard to say how much your bleeding was related to your fast birth. Do you know how they handled the 3rd stage? Did they do hard cord traction right after to try to get the placenta out? How much blood did they estimate you lost? Did they give the methergine after the placenta was out? If you are worried about your bleeding and want to decide about a future homebirth, I think I'd be worth it to get a copy of your records to get more answers. But, just so you know, I would have no hesitations about taking you on as a client. A prior PPH like you describe does not make you a bad candidate for homebirth at all.

 

[sbrinton]

I have a similar question.

I think my placenta may have abrupted at the end of my last labor. Labor began at 5 am but by 11:30 am, I was still at 3 cm. I went from 3 cm to baby out in less than one hour. There was a lot of bleeding - way more than just bloody show. The bleeding happened in the last 10-20 minutes of the labor and baby was out faster than the doctors could have done a c, but I think my placenta could have been abrupting.

I don't know if this was because of precipitous labor or that my water was ruptured for 11 days or that I had a low lying placenta, but it wasn't normal...

 

[MsBlack]

D Alicia--I totally agree with Reha.

Further, the word 'precipitous' concerning labor reminds me of a little rant I recently wrote here about the word 'delayed' concerning cord clamping: it is a loaded word, it sounds bad somehow....but what does it really mean? I don't even use the word anymore--tho I sure might say "this mom births really fast!".

'Precipitous' comes from 'precipice'--a 'nearly vertical cliff'. We use 'precipitous' to speak literally of cliffs and suchlike. We use it metaphorically to indicate danger, peril. How does this apply to birth, tho?

Seems to me that when we speak of precipitous deliveries, what we really mean is:
"mom gave birth/nearly gave birth in the car/in the elevator/into a nurse's hands instead of a doctor's" and "Doc/staff/mw wasn't really ready for that birth" (even if mom was already in the hospital or comfortably at home w/mw).

:

And in *those* situations, there *may* be danger for mom/baby, but I think that's mainly from trying to prevent birth from happening before staff and setup is ready. Tho of course, a mom birthing in a car might have troubles related to being in a car, the weather, panic, etc.

But I've seen a lot of really fast births and none of them presented more 'danger' or 'peril' than slower ones. In fact I'm generally more alert to danger from a really long labor than a really short one, given what I've seen (mind you, I've not seen a lot of problems with really long births either--but...well... that's a whole nother discussion).

This makes me think of Friedman's curve and just the general medical attitude that 'normal labor' lies within a certain set of parameters--time being one of the given parameters. So those who birth in a way that is outside those parameters is automatically considered to be in a danger zone.

I also think it is true that in *some* cases, babies come really fast because there is an underlying problem--and birth is the best cure for the problem. An abrupting placenta would be one of these. Mother and baby are most often emminently capable of working these things out during labor--whether or not anyone knows (intellectually, from 'evidence') that there is a problem.

So--I don't know if you bled enough during your last birth that I would have called it a hemorhage, but apparently it was more blood than medicos like to see. Maybe there was a partial abruption, or maybe your strong fast uterus just went ahead and released the placenta pretty much on the heels of the baby (which sometimes causes a greater initial blood loss than when placenta releases later).

I can see why you would be concerned tho. It's a good idea to get those records from your last birth, and go over it with your hb mw to see what you can see. Make sure you feel comfortable with her approach to pp bleeding and her protocols/techniques for managing excess bleeding. As Reha pointed out, those other things you mentioned as possible risks of precip birth just don't really manifest in my experience--now it all seems like pure speculation to me...hypothetical dangers created by med people who tend to think birth is dangerous anyway.

So- nothing you've said makes me think you wouldn't be a good hb candidate. And who knows, by staying home, maybe all will go just perfectly because you won't have the stress of travel and all the hoohaa over 'precipitous' birth.

 

[BrooklynDoula]

After both of my babies, I had a termendous, quick blood loss that suprised both of my midwives very much (two different providers) but I was fine. In the hospital they were more concerned about this and gave me a shot of pit in my thigh. I passed clots the size of a grapefruit but then it slowed.

Second baby was born at home. He came in about 5 pushes and the placenta came quick afterwards (did both times) and nearly feel on the floor. All the blood meant more clean up and I was glad I had a lot of towels, but they fed me and checked me and it was all good. I took an iron suppliment because my MW (and I) were concerned about my iron levels (she checked my eyes). I only bleed for about 24 hours and then panty liners after that for about 6 days.

No hard facts, just a BTDT. I hope baby #4 works out well for you when he/she comes along.
best,
Megan

 

[DoulaAlicia]

I would like to thank everyone for their replies. This has given me some confidence.

Midwives - if you were me would you want to make sure your homebirth midwife had pitocin on hand given my situation? (I'm asking because I don't believe it is legal for them to carry it where I live but I know some do anyway).

 

[MsBlack]

No. But I would want to know her plan of helping, should I bleed again excessively. And what herbs she carries, or wants me to have on hand, to help stop a bleed. I carry some herbs for use in surprise bleeds--but when I have a mom w/a history of bleeding, I ask that she get some tinctures for herself. If needed, we'd use hers instead of mine; if not needed, she can keep them onhand for her future births.

Oh yes, and I'd want to know what suggestions she might have for prevention of problems with bleeding--such as blood building nutrients during pregnancy. And I'd probably do my own research on that as well. Really, if I knew I had a higher risk than usual of bleeding, then I'd want to be ready myself to prevent, and to act if a bleed does occur....I dont' think I'd just leave it to my mw. But that's just me!

You know, eating/drinking sufficiently during labor, then getting hydrated and some calories soon after birth, seems to really help reduce bleeding and the impact of bleeding on women. I consider this to be another method of prevention.

 

[Reha]

Its great to hear your thoughts, MsBlack! Because, my answer would be that it would be important to have pitocin on hand. But, not because I think the OP sounds like she has a bad history of PPH (which I don't consider to be the case) but because having pit on hand is simply within my own comfort zone. But then again, I know I may feel differently if I weren't able to legally carry it. Geez, I can go down to the hospital pharmacy and buy pitocin, methergine, etc. I do also carry herbs, and I use those before the meds, and rarely need the meds.

OP, I wouldn't be *expecting* you to bleed too much, but I agree with MsBlack about doing all you can to work on prevention. I think also that in most cases, simply being at home, where you have more privacy and can focus more completely on your baby directly after birth without distraction, will also help prevent hemorrhage. Creating an environment in which the hormones of birth work for you to prevent excess bleeding is always my first defense against PPH.

 

[DoulaAlicia]

Ms Black - I do agree that it is very important to take on much of the responsibility myself, asking the right questions, keeping the proper diet, knowing what to do if I need to help myself. Do you think herbs are just as effective as meds though? I do need some education in this area and will embark on this soon.

Reha - I do tend to want that pit on hand "just in case". And I'm not expecting trouble either. But just want to be responsible about making preparations for that possible outcome since I had a bit of trouble last time. I also agree environment is going to make things better.

To both of you - I guess what I do have to consider as well is what to do in the event of an unassisted birth if it is at home. I labor so fast, what if the m/w isn't present!!!??? If I do the birth at home I do plan to have my mother here. She is a nurse and a doula herself. And I was hoping to talk to my m/w about making sure my mother is prepared for any type of overbleeding issue as well if she is the only one here - possibly even have her carry some pit. Not sure yet...things are very far off obviously but these are the things running through my head.

Thanks again for your input. I do appreciate it greatly.

 

[MsBlack]

Well--my experience/'numbers' are not as high as some here, but so far I have not seen any bleeds that did not stop with natural measures of nipple stim (BF or other), herbs, gentle fundal massage. Oh yes, and seeing if mom can pee--a full bladder can prevent sufficient uterine involution.

Also, by way of prevention I make sure all moms drink, eat, and pee regularly prior to birth; then soon after birth I am offering fluids with calories (a mom can drink some water of course, but within several minutes of birth I'm going to ask her to drink recharge, juice, sweetened tea, etc--something w/calories). I also offer food fairly soon--depending on the mom and situation, within about 15-30 min I offer a few bites of something or even a whole meal if she's ready. I don't exactly have a 'standard routine' with this--it's always based on the individual woman and her birth, signs, etc....I just make it part of the chores I do in the immediate pp hour, as indicated.

In my opinion, maintaining hydration and supplying some calories goes a long way in helping women to rapidly make the functional adjustments needed after letting out the weight/warmth/fluid of baby, amniotic fluid, placenta, blood. A woman's body undergoes a fairly drastic change as a baby is born--and we do have compensation mechanisms which can quickly re-organize/re-stabilize circulation and all, in the wake of that. I just think that the woman who is well hydrated and fueled and also is warm enough, will do this most efficiently--and this includes the most efficient, immediate involution of uterus, release of placenta (Not necessarily a rapid birth of the placenta, but it's release from uterine wall) and thus, control of blood loss.

I see very little by way of excess bleeding in the first place, tho my way of assessing may be different than some (particularly med HCPs). To me it is not the amount of blood, but how the mom is handling the loss that matters. Some women just lose a goodly amount of blood at birth (incl 3rd stage), and that is normal for them--their vitals remain stable, they are alert and cheery. Some lose almost none--the variation is astonishing to me actually.

In any event, I've only had a small handful who were starting to be negatively affected by their blood loss (faint, dizzy, clammy--one who passed out very briefly), but by using the above methods we got things under control and bleeding remained low once we did. I can't use pit--so I've never gotten used to thinking of it as a needed item! But I do know mws here who are able to get pit...one recently told me that she uses it so rarely (preferring the methods above) that it usually expires before it gets used.

You know, Alicia, while I do think it's important for any mom to be informed as you are doing, take any preventive steps she can, know how her mw handles such things....there is another element to all of this that I've been trying to articulate in my thoughts, concerning personal responsibility for one's body and birth. Let me put it this way--twice now, I have told women that they simply had to stop bleeding right now--and they did. Don't underestimate the power of your own will in all of this. Pregnancy and birth are at the same time things we must surrender to--and things we must be very directed and proactive about! We have to let go and allow--and yet we are not just passive passengers with no control over the ride. I just want to say--you just don't have to bleed too much at your next birth. Your body is designed to preserve your life, and birth is well designed to work properly for any reasonably healthy woman. Additionally, well, you can surely apply your mind to this issue as well.

 

[saintmom]

Not a mw,but I've done some assisting and had several precipitous births so here's my two cents.

If i'm at home I'd like to know my mw could handle a hemmorage.

Being freaked out,flight or flight mode had more to do the my precipitous births.They were in hospital,my least favorite place.

Nutrition,nutrition,nutrition.Can't say it enough.I just haven't seen or heard of well nourished,healthy women having bleeding issues,unless they were being handled roughly,i.e. cord traction.

Don't mistake a lot of blood right before or after the placenta delivers for hemmorage.The assistant at my last birth thought it was too much,but the midwife pointed out how it pretty much quit right after.In a true hemmorage it keeps coming.

Not all births are precipitous,my last was 36 hours.The previous one had been two hours!

 

[MsBlack]

I agree, Saintmom--

And so true--sometimes, with baby or with placenta or both, there is a gush of blood that can be quite a bit and seem alarming. But if it stops right away, if fundus immediately firms up after that loss, this is not hemmorhage in my book. To me, hemorrhage is when bleeding continues, won't stop.

I think some HCPs see that gush, a goodly amt of blood, and they immediately think 'hemorrhage', get worried without taking a moment to check fundus and watch for further flow.