Thoughts on post-partum hemorrhage (PPH)

These are my thoughts on how I've chosen to homebirth despite having had PPH and how I try to reduce the chances of having one. It's certainly not medical advice but merely what led me to research evidence-based solutions since the solutions I was offered didn't add up to me. Pray and do your own research. What is an acceptable risk for our family may not be for others.

I'm thinking about post-partum hemorrhage again. Of all my birth experiences, this was the most scary because seeing and hearing your blood pour on the floor makes you terrified that at some point someone won't be able to make it stop. And your husband will be left with all these kids. And the baby won't have a mom. And you'll be dead.

I had PPH with at least baby #7, a miscarried baby, and baby #8. With baby #9, I did not hemorrhage.

Except, I haven't died from it yet and I've had at least 3 PPHs. Knowing that, and thinking about my experiences has led me to consider if it would be possible to prevent PPH rather than wait for a provider to stop it after birth.

Four years ago I started to research uterine atony which is what leads to PPH. This is what I learned: 1. It is common in moms of lots of kids and it happens because the uterus is a muscle and it gets tired from having so many babies. There are other causes, but this is *my* risk factor.
2. Moms who don't give birth in a hospital are putting their lives at risk because they could bleed out before they have adequate treatment for PPH.
3. The way to manage PPH is for a doctor is to actively manage the delivery of the placenta.


I believe that birth is designed by God and that it is really designed to work correctly most of the time. If it weren't, the human race wouldn't have survived until doctors started being involved in birth in the 1800s. Of course, it doesn't work perfectly every time because there is sin in the world, but overall, when you look at the number of baby humans on the planet, I think we can say there is a good design there. This is what first led me to questions whether what I was reading about uterine atony was completely true. Why would the uterus be the only muscle in the body that gets worn out with use that is at best infrequent? My kids are approximately 2 years apart. So using my uterus for 9 months and then resting it for a year is supposed to be wearing it out and leading to PPH? I use my heart every day and it doesn't tire. If I want to build my other muscles, I use them more, even to the point of muscle failure, not less. If God designed birth, He wouldn't have designed it so it would kill the mom when she has more people to depend on her, would He? I don't think so. And it doesn't make sense that the uterus would work in a completely opposite way from all the other muscles in our bodies. That just doesn't make sense to me.

I think women should have babies in the most medically appropriate environment. Low risk women should be free to have a baby at home. High risk women should have the level of medical care they need. When I had twins, I gave birth in a hospital operating room so that I could have an emergency c-section if necessary. That was medically appropriate. They had great care they needed. Ironically, guess what? The anesthesiologist showed up after I had delivered 2 babies and my placenta, everyone was cleaned up, and I was being wheeled back to my room. That made me think about how responsive a hospital is. 

Years later, I had to have my miscarried son induced. He had died a few weeks before but wasn't delivering. I had a Cytotec induction (google that for scary birth and hemorrhage stories) and shortly after he was born, the nurse and I heard a sound like a faucet on and water pouring on the floor. I sat up and the sound went away. We looked around but didn't see anything. I lay back down and the sound came back. Then the nurse lifted my bedsheet and we saw a huge puddle of blood on the floor. (One thing to remember about blood is that it always looks like a lot!) Doctors and nurses came in, my IV was opened to give me fluids, started manual manipulation of my uterus and swept for retained placenta (ow), and gave me pitocin to help my uterus clamp. This was about 3 am. I don't know how long it took them to control the hemorrhage, but it felt fast. I was kept on IVs but wasn't given anything to eat. At 8 am, I was told they had decided not to give me a blood transfusion, removed my IV and told me not to drive home. I did because there was no one to take me. What I reflect on here was how they managed the PPH: IV, pit, manual manipulation. When I had a home birth, my PPH was managed in the exact same way. Also, notice that the blood transfusion was discussed and rejected 5 hours after the PPH, not as it was happening or in the time frame it would take to drive from my house to an ER. These made me wonder if a hospital really *is* safer than home with a trained CNM who carries pit and IVs in her bag?

As I healed from that  I had a friend tell me her PPH story. As she lay on the table bleeding, she looked to the nurse and asked if she would be ok. The nurse sorrowfully looked her in the eye and said, "I can't tell you that this will turn out ok." But she was in a hospital! I had been told that was the place to be because then I wouldn't die! Except, I know and am ok with the fact that we will all die at some point. I just really hope it doesn't happen during birth. Paula's story again made me consider whether a hospital was the most medically appropriate place for me to be when I gave birth again.

Fast forward 11 months. After doing a risk assessment and deciding to home birth the next baby, I give birth in a tub in my breakfast nook.

You can see the blood in the water. 

My midwife and I had discussed the PPH treatments many, many, many times so I would be very comfortable with how it would be managed. And they managed it exactly like the one in the hospital. There was no extra technology in the hospital. The midwife had the exact same tools: pitocin, IV, manual manipulation and sweeping. The whole birth story including my PPH is here. What I didn't mention is that when they moved me to the bed very quickly after this picture so the treatment was done there.

The rest and good food and environment at home helped me recover and feel better than I had in previous pregnancies. This was the first time Bill really understood how to care for me post-partum, how to keep the kids away, how to let me just rest and nurse the baby and eat and drink. My recovery and all around experience was great. 

But with the next baby I wanted even better. I wanted to have a baby at home. I wanted to *not* hemorrhage. I started to research what causes PPH. Medical answer: having lots of babies and wearing out your uterus so it won't contract correctly. I started to try to find a way to prevent it. medical answer: you don't prevent it. The doctor just tugs out the placenta and gets pit into you and deals with the PPH. Hmmmm.....

So I come back to my original thoughts. God designed birth to work and designed women to be able to have many babies. If this is the case, I do not believe that He would design the uterus to stop functioning in a dangerous way as a woman has more children. This mindset is wrong to me. Also, I truly believe women should be able to give birth in the most medically appropriate setting, not feel threatened or pressured by the overused "because you will die" argument or by insurance companies. If a PPH can be managed at home with the same tools as a hospital has, homebirth is a viable option. If a mom feels more secure in a hospital setting, I understand that too. I just don't think a hospital is necessarily the only answer. And doctors actively managing PPH is really only reacting to a situation. I truly believed in my gut there must be a way to try to prevent PPH. Also, the more I read, the medical advice for a doctor to tug out the placenta can actually lead to PPH because it can cause the placenta to tear and leave pieces in the uterus. There is actually a correct way to tug out the placenta and it takes finesse on the part of the provider. Tugging out an **attached** placenta (Which I've had done) can be dangerous. Tugging out an **unattached but undelivered placenta** allows the blood to flow out and the provider to assess whether a hemorrhage is happening. If one simply waits for the placenta to deliver, it can act like a plug, allowing blood to build up behind it but keeping the provider from being able to see the hemorrhage. Sweeping the uterus during a PPH is done to remove any pieces that might be there. My midwife had the completely opposite approach of allowing the cord to stop pulsing before cutting it and then allowing the placenta to deliver itself. My new midwife does the finessing the placenta out method. These thoughts led me to find what could help prevent PPH. 

The first and most important piece was faith. With faith and knowing that God would take care of our family whatever happened, Bill and I were able to go into this birth with very little stress. Also important to avoid PPH!

In the end I collected articles on a Pinterest board and started drinking smoothies with ingredients intended to help prevent PPH and made a plan with my midwife. It worked! With Lydia I did not have PPH. The smoothie recipe and story of Lydia's birth is here.

Here we are 3 years later. We are planning another homebirth in a new state with a new midwife. I'm rereading my articles, tweaking my diet and praying. And I feel at peace.

He's a preschooler

He wrote his own name.