PPH

If you`ve had one PPH are you more likely to have another with your next birth?

I`d love to have more children but the thought of maybe going through another severe PPH really scares me, I still haven`t recovered emotionally from this one.

Sorry, whats a PPH?

post partum haemorhage.

Dee I will ask Alan or Brenda to reply, as I am not 100% on something and I think its important you have good advice and support to avoid you possibly feeling fearful as the birth is imminent...

Dee, I had a PPH with Paige and mine was due to a retained placenta. I was worried that it could happen again, but my Dr reassured me that it most likely wouldn't, but then 1 in 25 births have a retained placenta apparently. I also believe that mine was attributed to the syncto drip I had. I think it would depend on the reason why you had the bleed as to whether it could happen again.

Although for future births, I am going to give blood so that i have my own blood supply if I need it afterwards.

Oh ok, I am sure if thought about it the peny would have dropped on that one.

Yeah augmentation / induction makes it more likely but I dont think Dee had that... can be a number of things but not always happening the next time. I think there is something you can take to help reduce chances of PPH but I may be confused, very vague on what I heard.

Here you go, from Syntocinon packaging apparently updated this year...

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ADVERSE REACTIONS
The following adverse reactions have been reported in the mother: Anaphylactic reaction, Postpartum hemorrhage, Cardiac arrhythmia, Fatal afibrinogenemia, Nausea, Vomiting, Premature ventricular contractions, and Pelvic hematoma.

Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.

The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.

Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.

The following adverse reactions have been reported in the fetus or infant:

Due to induced uterine motility: Bradycardia, Premature ventricular contractions and other arrhythmias, Permanent CNS or brain damage, and Fetal death.

Due to use of oxytocin in the mother: Low Apgar scores at 5 minutes. Neonatal jaundice, and Neonatal retinal hemorrhage.

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Hands up whose Obs tell them this stuff? Sorry to sidetrack. I just hate what the stuff can do, if you know pros and cons its easier to make an informed decision. If its lifesaving, its worth it. But the stuff is cheap as chips and it's handed out like it too.

The thing with artificial oxytocin inductions is that it does circulate the stuff in our body but you also need RECEPTORS to be activated on your uterus - its not just a matter of pumping drugs into the body to magically start labour... if the body isnt ready we may just have have failed inductions... the receptors activate when your body is READY for labour. So you may be getting a higher and higher dose for what? A more likely chance at a caesar/interventions when baby goes into distress. Hence why the dosages often need to be high to get you into labour especially when you are not in labour yet. More chance there are less receptors to get it going and labour is tougher with the increased levels of drugs. If you are interested in it, you should read up more on Dr Sarah Buckley's stuff - brilliant about hormones and interferences. Of course, for those who need an induction and if their body is ready it can work well.

Well I had synto both times and I had PPH both times. I am a bit annoyed that the second time, with Grace, that the OB didn't think to mention that the synto might cause PPH, especially since he was told that I had had one previously. I wasn't aware of any link at that time, it was only after I had Grace that I found out that the synto could have been a factor. That really is something that women should be told when discussing induction with their doctor or midwife, but when I was induced with my kids no possible side effects or adverse reactions were brought up or discussed with me.

Hmm, that bit about the low apgar scores is interesting Kelly. Paige had three tests done because she had a score of 6 at 1min, 7 at 5 mins and they repeated it at 10 mins and she got a 10. I assumed it was because of the late administering of the Peth that made her a bit doey - or it could have been a combination of the two. Her scores probably weren't as low as they are referring to, but she still needed the third test.

Peth can do that too Sherie - its a terrible narcotic, I wouldn't suggest to anyone to take it. The flat babies, feeding problems, respiratory problems, low apgars - I heard some maternity wards no longer use it, but many still do. It has a half-life in the baby of a bit over 8 hours from memory, much more than us. One of the world's leading authorities in breastfeeding & drugs has said its one of the two top contraindcated drugs with breastfeeding and urges against using it.

We actually had no problems with the feeding - although she did sleep for 6 hours that first night and we thought it was the peth, but then that was just the way she was in the end - a surprisingly good sleeper. I did only get it as a last resort and I know how it makes me feel, so I can only imagine that the feeling must be compounded in a baby.

Sorry for hi-jacking your thread Dee.

All side effects dont happen to all, sometimes some, sometimes all... No-one feel bad for the choices you have made though - how were you to know this? No-one tells you. Its terribly unfair and is why I am so hell-bent on making it known - not to judge but to bring this to the surface from where its hidden. The evidence is everywhere, just not accessible!

Hi,

Everyone is different and you cant guarantee that you wont have a second PPH next time around.

I had a sponataneous labour with my DS, no cyntocin given to me at all. But i had a prolonged labour with him as his head got stuck and i went on for hours longer than i should have. His heart rate started dropping dramatically and they moved me right over onto my side and said get him out quick hes in distress, this movement of position flipped his head to where it was meant to be and 10 mins later he was born.

But my uterus got tired and didnt want to contract anymore and i had a PPH. I lost 1500ml of blood. It was horrible but i am pretty sure it wasnt due to any retained placenta.

I have since had 2 more babies and not experienced a PPH again. They do watch you like a hawk when they know you have had a PPH previously. I am not allowed to get up for at least 2 hrs after the birth until they are sure i am not having a big bleed and they give me something to prevent a big bleed too, i have just found out.

Its up to you what you want to do, i can understand you apprehension.

Hi Deejoy
First let’s put things in perspective. PPH is defined as blood loss of more than 500mls. Now to an inexperienced Midwife, (and to the person who is bleeding), even 200 mls of blood can look like a massive bleed when spread over the bed/floor. A loss of 200 mls of blood in childbirth is quite common. Now I’m not trying to say that you did not have a PPH, I am trying to say that measuring the blood loss is a just an estimate and not very accurate.
There are only 3 things that I can think of that can cause PPH

• Atonic uterus.
Your uterus does not contract. If your uterus does not contract the blood vessels where your placenta was/is attached will not stop bleeding. When your uterus doe contract it is like putting pressure on an open wound or squeezing your nose to top the bleeding.

• Retained placenta or products
This can prevent your uterus from contracting. (See above)

• Tear of birth canal
You have a lot of blood vessels down there. If you tear one or two of the larger ones then bleeding can be a problem.

There are a number of things that can increase your risk of having a PPH.

• Previous PPH
This risk factor is somewhat dependent upon what caused the previous PPH

• Grand multiparity
5 or more previous births

• Polyhydramnios
Excessive amount of amniotic fluid

• Large Baby/shoulder dystocia

• Prolonged labour/2nd stage

• Oxytocin induction

• Instrumental deliveries
Vacuum/Forceps

• Low lying placenta

• Fibroids

• Full/distended bladder

• Age of mother

Looking at this list may scare you a little. This was not my intention. You do have 2 of the risk factors that can increase your chance of having a PPH with your next birth, but this does not mean that you will have a PPH. Should you decide to have another child, and I do not see any reason why you should not, your OB/Midwife will be aware of your history and will be well prepared for any potential problems.
On a side note. At the hospital where I work, we recently had a woman come in to give birth to baby number 10 :eek: . Labour was about 3 hours, she gave birth to a baby girl. 4150g (just over 9 lbs) on all fours, and only had a blood loss of about 300 mls.

Thanks girls and Alan for the info, yes Kelly you were right in saying I wasn`t induced.

My PPH didn`t start till 6 days post birth due to a large piece of retained placanta (even though on the paperwork it mention placenta was complete), anyway I don`t know how much blood I lost before they did a D & C on me but I lost so much blood at home I couldn`t sit up and my BP dropped so much that my vision was going anyway in hospital they couldn`t wait any longer (they waited 2 hours to give me antibitotics and hoping it would stop as they weren`t keen on giving me a D & C as it can cause problems getting pregnant later on) anyway they had to do a D & C in the end as the amount of blood going into me was coming out as fast the other end but during the D & C I did loose 4 litres of blood.

Hmm I have a number of risk factors in that list.

Dee
You can remove one risk factor. PPH caused by retained products does not increase your risk of having a PPH with your next birth.

Dee, I had a PPH after my second son was born. It happened 2 weeks later. Apparently I had retained placenta too, even though, like you it said my placenta was complete. I had a normal and spontaneous delivery, although I did have the oxytocin shot afterwards.

I had a c section with Noah and I remember reading my notes and seeing that they had written incomplete placenta or something like that. I was so stressed about it happening again. I ended up asking a midwife on duty and he told me that yes it was a possibility for me to have another PPH.

When I was pg with Tehya I told her what my notes had said and she told me that they have to write that on there witha c section becasue of the way the placenta gets taken out it is sometimes hard to tell if it's complete (something like that anyway).

As you know I went on to have a fantastic birth with Tehya. No medications at all, either before, during or after birth.