Haemorrhage risk with 2nd child

[meow951]

Just wondering if anyone can give me a bit of advice

Just wondering what is the risk of having a haemorrhage with a 2nd baby if it happened with your first?

Bit of background:

I wanted a natural birth with my son which i had in my local midwife unit, no pain relief, easy 5 hour labour, 3 pushes and he was out. He did have meconium when he was born so the cord was immediately clamped and i had the injection to deliver the placenta which plopped straight out. However, i did have a 2nd degree perenial tear and a labial tear which at they time they said was bleeding quite a bit and needed to be stitched. A few days later i went to the doctors feeling absolutely horrendous and was found to have an iron level of 7 and needed 2 iron tranfusions and iron tablets. At no point was i told i'd haemorrhaged.

Fast forward to this pregnancy and this midwife has told me that in my notes i'm down as having had a haemorrhage losing 600ml of blood. She has advised me to go to hospital rather than the midwife led unit.

The hospital is an hour away in bad traffic and is understaffed and generally not very good. I really want to have a natural birth with this one but obviously i will weigh up the risks to choose the best place to go. I'm just very confused as they never said i was haemorrhaging, i wasn't transferred to hospital, they weren't massaging my stomach of anything and didn't give me any drugs?

Sorry this turned out to be a bit long

 

[irish_cob]

I don't know the answer, but 600 ml of blood doesn't sound horrendously loads to me, according to my notes I lost just under a litre of blood, and that was with an emergency c section.

What were your iron levels like in your last pregnancy?

Can you ask your midwife for the medical/scientific evidence of repeat haemorrhage? Or even ask her to explain whether you did haemarrhage or not?

Anecdotally it seems that women usually (not always - but generally from what I've read - and this is not scientific evidence or anything) have a better labour and an easier birth the second way round, so it seems to me that the chance of it happening again would be less not more.

I'm also a bit confused about why she thinks you would be better off in a hospital, it seems they didn't look after you particularly well last time, you had to go to your GP several days after the birth. Clearly it wasn't great that no one treated you, but on the other hand, you didn't drop dead, so that suggests to me it's not an immediate emergency, so there's no reason why if there was a problem this time round and you were at home, you wouldn't have plenty of time to transfer into hospital if necessary.

 

[irish_cob]

Also can you get your iron levels up this time round in advance? That might help. I keep meaning to get myself some liquid iron like Spatone and get started on it daily now cos I'm already flipping shattered and I'm only 15 weeks!

 

[MindUtopia]

I wouldn't be worried about that at all if it was me (actually, I guess it is!). I had my daughter at home, like you an easy natural birth. I had a 2nd degree tear and lost 550ml. I also became quite anemic after birth (my HB was 9.9 or something like that) but I still felt very weak. Took iron and ate healthy and it was fine in a few days.

As far as I'm aware in order for it to count as a 'hemorrhage' you need to lose 1000ml or more. 600ml is pretty average and really it's just a guess because they have no idea how much you actually lost. If you had a tear, it's likely some of that blood was from the tear, not your uterus (which wouldn't even really count towards the overall total).

You might consider taking some extra iron towards the end to avoid the anemia, but I wouldn't worry about hemorrhaging. You aren't necessarily more likely to hemorrhage and you didn't really lose that much the first time anyway. Lots of women become anemic after birth, but you don't have to have a hemorrhage for that to happen (though if often can with a hemorrhage). You didn't get the transfusions because you lost too much blood, but because you needed iron and the fastest way to get that is by transfusion rather that through diet when your levels are really low.

My experience was very similar to your's (though I didn't opt for the transfusion, though they offered me one about 3 days pp to help with my iron) and I plan to birth at home again. I just plan to be prepared towards the end and take some extra iron in the latter part of 3rd tri and in the first few days after birth.

 

[meow951]

Thanks both of you, you've basically summed up what i've been thinking, from what actually happened and the midwifes reactions i really don't think it was a big deal either. My mum was at the birth and she finds the whole "haemorrhage" label really odd too.

The midwife who delivered my son was helping out as they were short staffed and hadn't delivered a baby in over 2 years. She seemed a bit out of practice and i'm wondering if she was a bit over zealous writing haemorrhage in my notes. I think i need to have a good chat with my midwife about what actually happened and see what she says.

In regards to my iron levels they're quite high 15 at the minute but i've got a re-test in 4 weeks. I'm taking vitamins daily and she did say she'd do extra tests after 28 weeks to keep an eye on it near the end of pregnancy. They were good in my last pregnancy too, about 12. They just dropped after he was born. To be honest i think it was just one of those things

 

[Feronia]

I had a homebirth and haemorrhaged as well, as I lost over 1,000 ml of blood. They put me on an IV (in my bedroom), injected me with something to stop the bleeding, massaged my uterus and pulled out a bunch of clots. I was very weak and pale for a few days, but after taking iron supplements, I was completely fine after 2 weeks when my midwife tested my iron. Not aenemic at all.

My point is that a postpartum haemorrhage can happen at any time (even with an easy birth like mine -- I didn't tear at all) and is easily treated at home, so your birthplace choice shouldn't necessarily take haemorrhageing into consideration. Midwives are prepared to handle this sort of thing anywhere. I have no idea about subsequent risks, but eating extra iron sources towards the end seems like a good idea (Floradix is good, too).