A month ago I received an E-Mail from a reader. Life has been quite busy so I haven’t got round to answering, apologies to the author. One of the reasons I have taken so long to reply is that I wanted to use the E-Mail as the basis for a blog entry as there are so many interesting points contained in it. Here I go then –
Copy of the E-Mail
I have just read your article which I found very interesting. I am currently pregnant and had twins 8 years ago, and am trying to find information on home birth after having a pph with the twins. I certainly wouldn’t go for the option of freebirthing but can you suggest a way that I can take control of my situation and find out what my actual risk is of having a pph again are.
I desperately feel like the area I am in is lacking in caring midwives, the first one I had was very abrupt with me and frightened me a lot, as when I asked at what stage would be best to discuss my birth options she asked me why and I explained that I hadn’t made up my mind but if at all possible wanted to go for a home birth, to which she replied oh they won’t let you do that as you will hemorrhage again. This comment coming without knowing any of my history or what happened in my twin birth as I was in a different county when they were born. I have since then changed midwives and have sent of for my old notes but I am still having major problems with disorganized staff as the midwife I have been seeing has my old notes to read but yet the midwife I can’t stand turned up for my appointment last week, and lol she didn’t even bring her stuff to monitor baby or me (blood pressure heart rate monitor etc).
The main problem I have is that I don’t believe that my twin birth would have ended up the way it did had they not looked at me as being a young mum that didn’t have a clue and bullied me into lying back when all I wanted to do was sit up as I wasn’t having proper contractions and was in constant pain (which they also didn’t believe until it came to feeling them to tell me to push as I had given in and let them give me an epidural) but could deal with that fine as long as I stayed upright . My instincts are telling me that I can give birth this time really well as long as I stay in a clam and relaxed environment, which would mean staying at home as every time I even go to the hospital just for a general appointment I tense up and start feeling unwell and just wana get out of there asap. Which I don’t think is going to be particularly good for going into hospital to give birth, I also really wanted the option to have my children with me if I feel good enough as they are very interested in childbirth and have watches a lot of births on TV with me over the years (graphic and not so and they still end up jumping up and down for joy when the baby arrives either way, lol).
I really didn’t think that almost 10 years on that I would feel so out of my depth, last time right up until the birth itself I felt so empowered as had done so much research and had spoken to so many midwives and doctors that I really felt I could give birth in a really good way. I have also wondered if my risk is so high for having a pph again why hasn’t someone spoken to me about having elective c section as I have known a couple of women who lost around the same amount of blood as myself and they were offered it to avoid the same trauma happening again as were equally effected as myself by the fact they were told they almost died.
Sorry for such a long email, should you want to ask me anything please feel free to contact me.
I look forward to your reply
As I observed before, lots of points here. The first question I ask myself is ‘ where does Sarah live’? I’m not talking the UK here as I feel confident about my ability to give advise about how to request a homebirth and what the criteria is in the UK for a homebirth request which won’t freak out the midwives. Anywhere else in the world and I have no idea!
Twins. For me this is a major fact which makes me wonder the relevance of the previous history with regard to this pregnancy and any risk assessment. A twin pregnancy is a high-risk pregnancy and birth, with one of the associated risk factors being PPH. It is obvious really that if a uterus has been over-stretched during pregnancy it is more likely that it will fail to contract down quickly and efficiently following the birth, so making a haemorrhage far more likely. Also, there will be either 2 placental sites or 1 large one so the area where bleeding is likely is larger. As a precaution against haemorrhage the synthetic hormone syntocinon is routinely infused following the birth of twins to ensure that the uterus contacts well.
8 years ago. When I was a student I was told that if it were more than 5 years since the last pregnancy then it should be viewed as if it were the woman’s first. If this ‘rule’ is used in this case then this provides another reason why the previous history should be ignored.
Lack of caring midwives. Difficult one! All can suggest is that Sarah discusses this with the manager responsible for community midwives. It may be that there is a clash of personalities, if this is the case then another midwife should be offered.
They won’t let you. The truth is that they can’t stop you. They can make it extremely difficult for you to have a homebirth but if you are persistent, involve the manager, the head of midwifery services and a supervisor of midwives a plan will be implemented. HOWEVER, there are constraints on the system and there can be uncontrollable circumstances which would mean that you getting your homebirth deprives other women of safe care. In many areas there are only 2 midwives on-call for homebirths so if they are already at another homebirth there would be no midwives available to come to you. Many units use the on-call midwives to cover busy times, low-staffing levels in the obstetric unit. If you demanded that they attend you at home the unit would be dramatically understaffed, the women there would receive limited care and the unit may have to turn away women. This is the way life in the maternity services goes, it does need a radical re-think, especially in light of the governments desire to increase the homebirth rate, but at the present time resources are seriously limited and so women arranging a homebirth should be aware of this and accept that their choice can/should not be guaranteed.
Elective caesarian section. Wow, talk about a sledge-hammer to crack a nut! CS it’s self carries a four-fold increase for the risk of PPH. I’m reluctant to comment on this as there may be medical problems, history which make birth by elective caesarian a more ‘manageable’ option.
So what would I say to Sarah? Chase up your old notes. Once you have them make an appointment to see the midwifery manager, take your partner or a friend with you. Go through your notes with the manager and ask him/her what the risk-factors are. If s/he says that you are at increased risk of PPH you should be under consultant care for the birth, request that you see the consultant and talk it through with him/her. If you are still unhappy then request a meeting with a supervisor of midwives, they are there for you. If the advise is still that you are high-risk but you are determined to go ahead then there are 2 options; tell the manager that you intend to have a homebirth anyway or employ an Independent Midwife.
I cannot say whether you are low-risk, therefore I should not, and will not say whether you should push for a homebirth but I will say to speak personally to as many well-informed professionals as possible and to be guided by them.
I will say please do not freebirth, especially not with your children present. If you did haemorrhage again no amount of watching videos or discovery health would have prepared them for the reality of a collapsed Mother and litres of blood.
Reading this through I don’t think that I have been of much help but for me to judge risk-factors without reading your medical and obstetric history would be foolhardy.