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Discussion Starter #1
Hi ladies,<br><br>
I had an ncb hb this past July w/ds. The birth went beautifully -- 5.5 hrs. from 1st ctx to dh catching -- including 17 min. of pushing. He was 9 lbs. 13 oz., 22.5".<br><br>
It took a "really long time" (~45 min?) for the placenta to detach and deliver. After they got ds all wrapped up, they had me lie down in bed and latch him on while they "inspected the damage" down there. I had a secondary tear and a couple smaller tears (I think) -- I birthed in a standing squat. The mw seemed a little concerned that the placenta was taking awhile and I think I had started to hemorrhage at that point.<br><br>
Long story short, they gave angelica and shepherd's purse tinctures, had me drink a "placenta smoothie" and put a piece of placenta under the tongue -- the bleeding continued. As they were stitching the tear, I lost consciousness (due to blood loss, I assume). They continued giving the tinctures, did uterine massage and told me to visualize my uterus clamping. Nothing helped.<br><br>
My bp plummeted to 44/32 and that is when they gave pitocin I.M. in my thigh. The bleeding then stopped. They tried to get an I.V. going, but couldn't get it into a vein -- so the paramedics were called (and they got the I.V. in in my hand) and I transferred to the hospital.<br><br>
So -- on another board I frequent, someone said she thought this all sounded negligent and that the mw's should have given pitocin sooner (I think about 2 hours passed from birth of ds to transfer). I, on the other hand, seemed to think that upon agreeing to a hb w/mw's, I was "signing up" for a more "hands-off" and "wait and see" approach type birth.<br><br>
I don't harbor the mw's any ill will -- I think they did what they normally do for pph, and I just didn't respond to their standard protocol... But now I'm wondering if maybe they should have been more aggressive and so I wonder what you ladies think?
 

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I am not sure what qualifies as negligent these days so I can't answer that.<br>
I had wonderful and very hands-off midwives last time. I ave birth at a small birth center in a bedroom like my own - nothing medical of any kind - and upon my request I was left to labour alone with my DH 90% of the time).<br>
Knowing about my history of heavy bleeding after birth, my midwives had pitocin ready for right after I gave birth. I bled A LOT even with the pitocin, so had they not given me the shot, I would have ended up in the hospital. I personally think it was a smart and prudent thing to do
 

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Discussion Starter #3
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<div>Originally Posted by <strong>polihaupt</strong> <a href="/community/forum/post/7953080"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I am not sure what qualifies as negligent these days so I can't answer that.</div>
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Yeah, I'm not necessarily asking from a "legal" standpoint or anything -- I would never consider legal action or anything like that. I just became curious about it after hearing someone thought it sounded "negligent."<br><br>
I didn't have pph w/dd -- at least not that I know of (horrible failed induction for "big baby" hospital birth experience). If I were to have any more (pretty sure we're done), I'd request the pitocin immediately, I think.
 

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Basically, negligence has to do with the accepted standard of care. If whatever care was given fell below the standard of care that an ordinary and reasonable midwife would have given it would have been negligent. This probably sounds like gibberish, but it is why they always have experts testify in medical negligence cases. They testify to what the standard of care should have been.<img alt="" class="inlineimg" src="/img/vbsmilies/smilies/dizzy.gif" style="border:0px solid;" title="Dizzy">:
 

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I don't think it was negligent at all. They were taking care of you and using a variety of techniques to try to get your body to respond. When it became necessary, they used a more aggressive treatment. I think they probably could have given you the pitocin before your blood pressured dropped since you weren't responding, and you might not have transferred. Perhaps they should have asked your preference, since they did have the pitocin available. But no, not "negligent."
 

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i dont know, its hard to say without being there, but from what you describe it seems like pitocin would have been indicated a lot sooner, after it became apparent you weren't responding to herbs/massage, and especially after you lost consciousness.
 

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I personally would have preferred the pitocin to going to the hospital, but my midwife and I had already talked about that scenario beforehand and agreed on what the protocol would be. I've had pit after both births, FWIW.<br><br>
But it sounds like you're happy with the job she did and how your birth went and that's all that matters, you and your baby are healthy so who cares?
 

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I would say no. I agree with some of the pp's who have stated that it seems like they were trying different things to see what your body would respond to and when the situation worsened the interventions became more aggressive. (Also, from what I've read, the 'normal' time for a placenta to detach can be anywhere from 30min-2hrs. Of course some of us take a shorter time, some take longer.)
 

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passing out happens after birth not always from blood loss-- I would not have considered your mws to be negligent<br><br>
so it took 45 min for the placenta to come--<br>
how long for the ambulance to get there? 15/20 minutes? so that is an hour right there- so spending about an hour trying to control a hemorrhage and suturing ... before calling someone else-- not too bad<br><br>
what were these people thinking that the mws should have started with a shot? I know a midwife who has practiced for about 30 years and in that time has only given 1-2 pit shots because she was assisting another mw-- so in her own practice she has not used it at all - very good midwife very accomplished midwife- she uses placenta, her hands, ice nipple stimulation ---<br>
people can be so judgmental and brittle when midwifery as well as medicine are arts not industry-- industry gives you a cookie cutter response to every situation -- tough luck if you wanted a different experience..<br>
your midwives were fine.
 

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Whats negligent is when you point out the hemmorage and they do nothing (that happened at my hospital birth). At least they were trying to stop the hemmorage. When I had my pph in the hospital even there they didn't reach for the pit first. It should be a last resort type thing.<br><br>
I don't think 45 is a long time for a placenta either. Mine take about that long. My last one took 30 min.
 

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I received pit much sooner than that, but it was sort of precautionary and I was given the option. I had lost a lot of blood and passed out at that point (though I passed out when I was trying to empty my bladder, which didn't work at that point, so I didn't actually feel that it was just blood loss). My placenta was out by that point, too, and came rather quickly. My MWs did NOT, as far as I recall, try other herbal treatments for the excessive bleeding.<br><br>
So I don't know that yours were negligent, though I'd hate to have to transfer if there was an option to avoid it, kwim? I was also quite satisfied with my postpartum care from my MWs, despite the fact that *maybe* it was a little early for pit. There really is no hard and fast rule, I think! If you are satisfied and felt well cared for and attended to, then I think all is well.
 

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<div>Originally Posted by <strong>Sweetiemommy</strong> <a href="/community/forum/post/7954391"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I don't think it was negligent at all. They were taking care of you and using a variety of techniques to try to get your body to respond. When it became necessary, they used a more aggressive treatment. I think they probably could have given you the pitocin before your blood pressured dropped since you weren't responding, and you might not have transferred. Perhaps they should have asked your preference, since they did have the pitocin available. But no, not "negligent."</div>
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<img alt="" class="inlineimg" src="/img/vbsmilies/smilies/yeahthat.gif" style="border:0px solid;" title="yeah that">:
 

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It does sound as though they could have been a little more aggressive -- if it were me and placenta and massage didn't start working almost immediately, I'd be concerned. It may be though that as far as what they could observe from blood loss and the way you were acting, it didn't look like an emergency situation until your blood pressure dropped and you lost consciousness. Were they monitoring your heartrate all along and it was a sudden drop?<br><br>
It can be hard to place an IV! Once in the ER three different people tried to get one into my eight-year-old son to no avail, and the fourth person finally succeeded.
 

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I too had a PPH with DD. In my case the placenta was still attached a tiny bit and my midwife needed to go in and get it.<br><br>
I was the first person to know something was wrong, I was sitting on the birth stool waiting for the placenta and I started to feel cold and my lower legs went numb. DD was not interested in nursing at this point, so no help there. The bowl underneath me did not have much blood in it, so there was no other indication that I was bleeding. I got a shot of pit at that point. I may have been given some herbs, I don't remember.<br><br>
I laid down and asked for oxygen (maybe was offered?). I know I felt it was important to stay awake. Things got fuzzy for me from that point. All I remember was sucking oxygen, staring at DH holding new DD and not being able to not look away from her. I kept reassuring DH I was OK (I'm sure I looked pretty bad at that point-he looked very scared). I had stopped bleeding and was resting at this point.<br><br>
My midwife had a bit of a conference with her assistant and DH about what she wanted to do (I was not aware of the group discussion) and then told me she wanted to try to get the placenta out. The idea of transferring came up at this point but I did not want to go yet. We had discussed this scenario during our prenatal so I was not scared and said something like "just get it out". I was ready to be done and hold DD. Well she did, it hurt, but nothing like labor, and out came placenta (she needed to help it detach-so she was not being overly aggressive). I got another pit shot and all was well.<br><br>
I was weak for a week or so after that. I had lost a good amount of blood. I never needed to go to the hospital. I did not develop any infection.<br><br>
I never felt like there was any negligence. We had discussed the possibility of this kind of situation so I knew what was going to happen. I could have had more aggressive treatment or transfered at any time, I just preferred the wait and see approach we took.<br><br>
Midwives all have different protocols and comfort levels. Sometimes the state mandates certain actions. I felt very lucky to be in a position were my midwife could use her best judgment and we had a say in what was going to happen.<br><br>
Were I live now all the midwives I interviewed said they give the placenta 30 minutes and then it's off to the hospital. And they all said that my previous birth was mis"managed" and my midwife probably caused the PPH. Since we pretty much had a UC with a "just in case" midwife I don't see this as a valid opinion.<br><br>
I think Mommas have different expectations about what will happen in certain situations (and ideas about what is safe or requires a hospital). If you want a managed, more medical home birth it's important to find someone who will provide that type of care. Others want the hands off, wait and see approach and look for someone who will be comfortable doing that. If you feel your care matched your expectations then other's opinion about what was negligent or not should not matter.
 

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I can see how a medical person would call it negligent, because their instinct and training is to intervene at the first sign of any possibility of trouble.<br><br>
I wouldn't, though, because they were doing lots of stuff, it just took a while to find the one that worked. And it turned out ok, right?
 

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<div>Originally Posted by <strong>AbbieB</strong> <a href="/community/forum/post/7960149"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
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Midwives all have different protocols and comfort levels. Sometimes the state mandates certain actions. I felt very lucky to be in a position were my midwife could use her best judgment and we had a say in what was going to happen.<br><br>
Were I live now all the midwives I interviewed said they give the placenta 30 minutes and then it's off to the hospital. And they all said that my previous birth was mis"managed" and my midwife probably caused the PPH. Since we pretty much had a UC with a "just in case" midwife I don't see this as a valid opinion.<br><br>
I think Mommas have different expectations about what will happen in certain situations (and ideas about what is safe or requires a hospital). If you want a managed, more medical home birth it's important to find someone who will provide that type of care. Others want the hands off, wait and see approach and look for someone who will be comfortable doing that. If you feel your care matched your expectations then other's opinion about what was negligent or not should not matter.</div>
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Well said! What matters most is how mother feels about the experience.
 

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i think it depends on whether you discussed this kind of thing ahead of time or not. my m/w has already talked to me about hemmoraging, and how i have 2 options: to get the shot of pitocin right away or "wait and see" and that she prefers to give the shot right away, etc...<br><br>
so anyway, in my case, if i opted for the wait and see approach and had a situation like yours, then the answer would be "no negligence"<br><br>
did you guys discuss this ahead of time?
 

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Personally, my flow of care immediately postpartum is different:<br><br>
- Baby comes out; is assessed for immediate needs and they are addressed if necessary.<br>
- Placenta comes out; bleeding is assessed and addressed immediately.<br><br>
If mother and baby are stable, we move on:<br><br>
Mom and baby nurse; mom eats and drinks.<br>
Mom gets up to urinate.<br>
Bottom is inspected and repairs are taken care of then if necessary.<br><br>
In other words, repairing her bottom is the last thing on my mind. I do not want to be dealing with a hemorrhage with a half-repaired bottom and suture pack open. Mom needs her blood! I don't mess around with herbal combinations while she's bleeding out to decide. They get one chance to work and I'm moving on. FWIW, I've never worked with any midwife who would move on to suturing before placenta is out and mom/baby are stable.
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>metromidwife</strong> <a href="/community/forum/post/7964363"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Personally, my flow of care immediately postpartum is different:<br><br>
- Baby comes out; is assessed for immediate needs and they are addressed if necessary.<br>
- Placenta comes out; bleeding is assessed and addressed immediately.<br><br>
If mother and baby are stable, we move on:<br><br>
Mom and baby nurse; mom eats and drinks.<br>
Mom gets up to urinate.<br>
Bottom is inspected and repairs are taken care of then if necessary.<br><br>
In other words, repairing her bottom is the last thing on my mind. I do not want to be dealing with a hemorrhage with a half-repaired bottom and suture pack open. Mom needs her blood! I don't mess around with herbal combinations while she's bleeding out to decide. They get one chance to work and I'm moving on. FWIW, I've never worked with any midwife who would move on to suturing before placenta is out and mom/baby are stable.</div>
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what if the bleeding is from a tear?<br>
is this the only way you can see a birth being done?<br>
Personally I have given multiple shots of pit and pit mixed with methergin and still had to hang an IV no one kind of care or treatment is infallable-- the mws did their protocol- one step after another and kept responding- including transfer of care do you really see incompentence? grasping the uterus firmly - having a dad do nipple stimulation with hands or mouth - often I start with herbs, depends on the bleed and the mom-- I have also had non-bleeding moms pass out- something else in the line of protocols for bleeding- empty the bladder... suturing may very well be something I would do in the decision making tree, especially if I see a bleeding vessel....
 
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