Having a bit of a crisis...

[Inertia]

I guess I am wondering if anyone else has any experience. I am trying to work out whether to go for another phys third stage. I know with a prior history of PPH, I am 3 times more likely to have another PPH - however - PPH is only 5%, so 3x is only 15%. Still small by comparison. I just know that asking for it is going to take a *lot* of effort - and I really do believe I can do it without any problems. Lyta's active labour was 18 hours, and even the midwife the other day said it was little wonder there was a severe PPH following that - but they define severe as >2500mls loss. Yes, there was >2500mls loss - over a period of well OVER an hour. So I dont like to consider myself severe because women have become severe a lot faster than I have, and its not fair to them to call mine severe because it took an hour and a half for it to get that bad. Blah - rambling.

Anyway - has anyone else got with an unmanaged third stage after PPH? If so just a couple of questions.

Did it happen again?
How bad was your original PPH?
Do you know what led to the PPH?
Was your after-pph labour completely natural as well?

Either way, I will be agreeing to a small canula as a precaution, but I just want to be left alone this time. I don't plan on doing this again and I want to experience the whole thing by myself without constant interruptions and interference.



Any opinions at all from anyone with any kind of knowledge also appreciated.
Hopefully after this thread I may have an idea of if I can really achieve that goal.

[Pretty Butterfly]

Hi hon.. I have never had a PPH, but just had bubba #6...

I asked for no canula, as I hate them and no history of any complications after birth, ever. But they talked me into it.

With each pregnancy and birth, the risk of PPH is greater, and with #6, the risk is apparently pretty high... I said "well then, put one in after the birth, if need be". But the problem then is if you bleed out too fast, and the veins colapse, your in trouble.

So I gave in. Within hrs after birth, and no great blood loss, they took it straight out. All natural, no injection for 3rd stage. I had the canula, so they had no reason to give me the injection for "just in case"

Good luck with your decision hon....

[Inertia]

Yeah. See, thats the thing. I hate needles with an absolute passion, but will allow the canula as a just in case. Still arguing the size and I can see why they are arguing for the thick one (veins collapsing and all that) - but they used the small one WHEN I was having a PPH, so it seems reasonable that if they have to prevent one much earlier than me already missing half my blood volume - it should be right!

And yes, the amount of kids ups my risk too. Well, I guess there is always hope. Not looking good atm tho.

[Midwife Melissa]

Hi there,

I'm going to be a bit blunt here - what are you really trying to ask? Because no-one can give you a guarantee, and there's no crystal ball. You might opt for a managed third stage and bleed, you might opt for a natural third stage and be fine. No-one can tell you for sure. Maybe what you're trying to ask is along the lines of: Can I feel ok about myself if I choose a natural third stage and I bleed?

Another way of looking at the situation is to explore what you can do to minimise bleeding (I'm sure you've done this already) and boost your body's ability to withstand bleeding.

Although there's an increased chance of bleeding again, as you so rightly point out, it's still in the minority. At the end of the day, you have to be happy with the path you take.

Melissa.

[paradise lost]

How much interference can you tolerate and how much risk would you take?

You say this might be the last time you do this, so obviously it's important to get it the way you want it, if possible. BUt as Mel points out, none of us are psychic so only you can know what is tolerable and what isn't.

You could take iron (liquid is best to avoid constipation, though it's not cheap!) the last 4-6 weeks of pregnancy, and take calcium (which muscles need to contract - taking large doses in labour can be helpful too) for the same period, you could think seriously about taking a bite of raw placenta as soon as it appears, get a homeopath to prepare remedies for you to hasten the 3rd stage and work on foetal positioning so that this birth can be as easy as possible on your uterus. You could use clary sage inhalation in the 3rd stage to help the uterus contract...i could go on!

Or you could have a canula placed and not have anything run through it unless you are bleeding.

Or you could decline the canula and hope for the best.

I think you need to sit down seriously and work out HOW important a natural 3rd stage is to you. It doesn't matter if it seems a "little" detail to others, you need to be honest with yourself about how much you care about it. I hope to have 3 babies in total, and if none of them are freebirthed i'll be disappointed. I know lots of women go through so much and just want a live infant to take home after their labours, but i am walking my road, not theirs, and birthing a baby entirely on our own (DP and I) would be magical to me.

Work out how much it means to you, and from there you'll be able to work out how much you're willing to do or risk to get it.

Bx

[Cricket]

Can you discuss your options with your caregiver? When I was getting ready for DD3, I talked to the midwife about the options for 3rd stage, and she said that if everything went well, they would certainly leave me to deliver the placenta naturally. If my labour was unusually long, or unusually short, they would administer the oxytocin shot right after DD was born. I had a homebirth, so avoiding a bleed for me was particularly important. I didn't want to have to transfer to hospital while recovering from birth. My active labour was 2 hours - pretty short - so she gave me the shot. I was fine with her judgement on that.
Is it possible for you to make an arrangement with your ob/midwife like that? Can you trust their decision, based on the circumstances? You can write out your wishes, listing the different options, and discuss them with your doctor, maybe, and then hopefully you can come to a conclusion where you know your doctor understands your wishes, and will respect them, keeping you and your baby safe, but not unnecessarily interfered with.
All the best for a great birth!

[Inertia]

Melissa: What I am basically asking is if anyone has done it before, or known anyone who has, and how they achieved it. I certainly accept that natural and bleed is a possibility, and that is why I have opted for a hospital and canula, the two things that play on my one phobia (Blood-injection-injury). I don't really feel like I will feel guilty for trying when I have allowed just enough doubt to be prepared for it. I am just looking at all the angles before I start the long battle of re-explaining my wishes over and over ... and over in the public system.

Hoob: I have a BT in a week and have been working on trying to build my iron levels back up (it was 117 and that is already going to illicit a dozen flat no's) so that they might be more inclined to give me a chance. The calcium info is good. Wonder if thats why I am drinking so much milk, LOL. I also have ruled out any form of anti-coagulant for the third tri, such as asprin. There is nothing more I'd love to do than decline the canula! Unfortunately, I am going to let it be placed because I suffer syncope when a needle penetrates the skin. When they had to place the canula during my PPH, my blood pressure near enough bottomed out with the lack of blood AND syncope (60/20) - so its safer for me to have it done before hand. And yes - want to walk my road - just once. If we were discussing something to do with the birth - and the baby was involved, my decision making process would be completely different. I know I will walk away from this labour no matter what - but the only person I am asking to recover is me, and I wont let it get as far as it did last time, so I know I can do that too.

Cricket: I certainly can discuss it, but I doubt I'll ever see them again. *sigh* Public system is a pain. No continuity at all. I will certainly accept their call if they say its gone over the acceptable mark, or if I have laboured far too long (what caused it the first time) - but if everything else has gone right, then ...

[Toomanytoomany]

Yeah. See, thats the thing. I hate needles with an absolute passion, but will allow the canula as a just in case.

I think that's a really reasonable compromise - nothing routine but you'll have a canula placed and will accept treatment if it is required by clinical indications. It will be apparent pretty quickly whether you are going to need drugs and blood. I'm glad you acknowledged the whole grand-multi additional risk too, although I believe this is a little overstated at times.

I wish you wisdom in your decision - there are health consequences to a medically managed third stage, and people often don't acknowledge that. I've had post partum infections from placental remains that have been left behind because of a synt-stimulated uterus clamping down on a placenta that a doctor is applying traction to in order to remove it. After pains following syntocinon are just that little bit worse too, and for us multis, we already know that after pains are a significant problem!

But even a well managed haemorrhage can lead to issues, not least of which is that it can delay your milk coming in, not to mention a longer recovery for you. So only you can know whether the risks are worth it, and what your cut-off line for accepting medical intervention is.

I've never had a pph, but I am aware of my increased risk because of my age and parity, so I'm making sure my iron is well up, and I have opted to have a medically managed third stage.

Best of luck!!

[Cricket]

Ah - sorry Inertia - I sometimes forget the system is different where I am, compared to where you are. I understand the spot you are in then. All the best!

[Toomanytoomany]

Cricket: I certainly can discuss it, but I doubt I'll ever see them again. *sigh* Public system is a pain. No continuity at all.

I suggest that you have it written down on a piece of paper in your labour bag to hand to them to stick on your file/case notes while you are labouring, so that anyone during handover or doing anything for your care can see what you have consented to and what you haven't. And use that language: "I do not consent to abc unless xyz". And sign it. That's what I intend to do re antibiotics if I am group b strep positive - "I do not consent to the use of antibiotics during labour unless I am labouring prior to 37 weeks gestation, I am running a fever over 37.5, or my waters have been broken for longer than 12 hours." Whilst they might consider they can bully you into accepting alternative treatment, having a written statement refusing consent unless you expressly countermand it is pretty powerful.

[Toomanytoomany]

sorry, double post!

[Cricket]

TMTM - that sounds like a good idea to me.

Inertia - I think there are some herbal things available to help prevent post-partum hemmorhage. Raspberry leaf tea is supposed to help, and I think there are some others too. I'm afraid I'm not too well informed on all the herbal stuff available, but I imagine some careful google searching, or a chat with a local health food store owner might give you some good ideas. Just a little extra "insurance" maybe?