PPH - When do the risks go up?

[Cricket]

I've heard before that your risk for post-partum haemorrhage increases when you've had a number of children. Can someone give me a clue as to when the odds start going up? I'm expecting number five, and planning a homebirth. I do not plan to change my mind over this, but I would like to know what the probability of PPH is. I've never had any trouble before with post-partum bleeding, nor had a long labour or a big baby. Anyone have some information on this?

[Trillian]

The odds of it happening apparently increase with baby number 4, or if you have already had one. I don't know what the actual percentages are though

[BellyBelly]

I dont have any stats on hand but your midwife would have synthetic oxytocin in case. I have heard from many sources (and yes this is squeamish!) that licking your placenta can stop / prevent PPH too! Google it, I am sure you will find something on it!

Your risks of PPH greatly increase with that many and subsequent c/s and also inductions but I would assume it wouldn't be as much for a normal birth. Perhaps speak to a naturopath too, there might be some things you can do now and at the birth.

[Roryrory]

I'm interested too - having #3 at home with no previous probs and this is something I am keen to be aware of too....

[Alan]

I don’t have the actual numbers but it is suggested that there is an increased chance of a PPH after baby number 4. However this does not mean that you will have a PPH. Last year I had a client who had a PPH and did try to slow it by eating a small part of her placenta. Unfortunately this did not slow the bleeding enough so I ended up giving her an injection of Synticinon which did stop the bleeding.

[~Raven~]

Is it also related to how fast the labour was too? I recall the consensus was that my PPH was mostly due to my uterus being too fatigued to contract because it worked too hard and fast, more than the fact that it was my 4th baby.

[Cricket]

Hmmm..... OK, well I don't think I can handle the thought of eating or licking placenta, no matter how beneficial it is. I've had the synto injection before with no issues, so I'll just plan on having that if it becomes necessary.
I might do a little googling and see if I can come up with some stats. If I find anything helpful, I'll post them back here.

Thanks for the feedback everyone! I really love having BellyBelly as a resource.

[Cricket]

OK, here's an article I found from the University of Virginia (USA).

Postpartum Hemorrhage
What is postpartum hemorrhage?

Postpartum hemorrhage is excessive bleeding following the birth of a baby. About 4 percent of women have postpartum hemorrhage and it is more likely with a cesarean birth. Hemorrhage may occur before or after the placenta is delivered. The average amount of blood loss after the birth of a single baby in vaginal delivery is about 500 ml (or about a half of a quart). The average amount of blood loss for a cesarean birth is approximately 1,000 ml (or one quart). Most postpartum hemorrhage occurs right after delivery, but it can occur later as well.
What causes postpartum hemorrhage?

Once a baby is delivered, the uterus normally continues to contract (tightening of uterine muscles) and expels the placenta. After the placenta is delivered, these contractions help compress the bleeding vessels in the area where the placenta was attached. If the uterus does not contract strongly enough, called uterine atony, these blood vessels bleed freely and hemorrhage occurs. This is the most common cause of postpartum hemorrhage. If small pieces of the placenta remain attached, bleeding is also likely. It is estimated that as much as 600 ml (more than a quart) of blood flows through the placenta each minute in a full-term pregnancy.

Some women are at greater risk for postpartum hemorrhage than others. Conditions that may increase the risk for postpartum hemorrhage include the following:

* placental abruption - the early detachment of the placenta from the uterus.

* placenta previa - the placenta covers or is near the cervical opening.

* overdistended uterus - excessive enlargement of the uterus due to too much amniotic fluid or a large baby, especially with birthweight over 4,000 grams (8.8 pounds).

* multiple pregnancy - more than one placenta and overdistention of the uterus.

* pregnancy-induced hypertension (PIH) - high blood pressure of pregnancy.

* having many previous births

* prolonged labor

* infection

* obesity

* medications to induce labor

* medications to stop contractions (for preterm labor)

* use of forceps or vacuum-assisted delivery

* general anesthesia

Postpartum hemorrhage may also be due to other factors including the following:

* tear in the cervix or vaginal tissues

* tear in a uterine blood vessel

* bleeding into a concealed tissue area or space in the pelvis which develops into a hematoma, usually in the vulva or vaginal area

* blood clotting disorders such as disseminated intravascular coagulation

* placenta accreta - the placenta is abnormally attached to the inside of the uterus (a condition that occurs in one in 2,500 births and is more common if the placenta is attached over a prior cesarean scar).

* placenta increta - the placental tissues invade the muscle of the uterus.

* placenta percreta - the placental tissues go all the way into the uterine muscle and may break through (rupture).

Although an uncommon event (one in 2,000 deliveries), uterine rupture can be life threatening for the mother. Conditions that may increase the risk of uterine rupture include surgery to remove fibroid (benign) tumors and a prior cesarean scar in the upper part (fundus) of the uterus. It can also occur before delivery and place the fetus at risk as well.

[Cricket]

And, from what I can tell, your risks go up as a "grand multipara" - five or more pregnancies.

It sometimes strikes me as funny that at five kids, I'm a "grand multipara". 100-200 years ago, this would have been just the start of most families, whereas now, people look at me like I must need therapy, or something. And back then, they had no washing machines, no dishwashers, no superstores, no disposable diapers, no fancy cloth diapers....

[deletedit]

I'm having #3, I live in the country where 2-3 is very normal (I haven't seen anyone yet with more than 3 here ... well, except that woman with 7 that everyone talks about behind her back because that's so WEIRD and stuff - and they somehow run a digital editing studio from home with 7 kids?!) but if I was in the city I'd be branded insane for more than TWO. Times change

[caplaylolmay]

Hi i had my baby girl 3 weeks ago and i had a PPH 12 hours after her birth and the doctors told me the most likely cause was because my labour was so quick and being my fourth child and also because i had only had a baby 17mths ago they were all the answers i got.

[Olive]

i had a PPH and they think it was from a tear in the vaginal wall and not from the uterus, i also had a few bad haematomas