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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Oct 18
    2012

    Postpartum hemmorage/accreta/coccyx fracture

    Meagan Londy
    Dear Ms. Goer, First of all, thank you so much for taking the time to read my question. Your accessibility as an expert in the field is unique and so appreciated. I had a very traumatic birth with my daughter who is now 16 months old.  I labored for 16 hours with contractions very close together the whole time. There was no "early labor" and after 6 hours, I arrived at the hospital 7cm dilated.  I received an iv with antibiotics because I was gbs positive but had no pain medications or interventions.  My labor did slow once at the hospital but my midwife was supportive and did not intervene. I never did feel the urge to push and did allow my midwife to direct my pushing (possibly it was too soon to push), and this resulted in 3 hours of pushing. I did much of it on my back due to exhaustion and because at that time I was on the continuous fetal monitor because there was meconium in my amniotic fluid. When my daughter was born, she was taken immediately to the nicu for meconium aspiration.  I pushed out the placenta at 35 minutes post birth. I then lost 2 liters of blood due to postpartum hemmorage.  I also had broken my coccyx while pushing. Once my daughter and I were discharged I continued to have heavy bleeding and clots. Then, at 4 weeks postpartum, I hemmoraged again at home. I was rushed to the hospital and had an emergency D&C.    I had had retained placenta. The retained product was 7x4cm. At my follow up 4 weeks after the D&C, the ultrasound showed more retained placenta. Another D&C was not performed for fear of uterine rupture, and I was diagnosed with placenta accreta.   Also, at 16months postpartum, I am ovulating but have not had a period. My doctor believes this is due to uterine scarring. Ms. Goer, I am terrified to give birth again. I believe so completely in natural, intervention free birth, and that nearly all women can birth safely without medical intervention. And I am devastated that I'm an exception.  Due to my post traumatic stress and subsequent terror of experiencing another trauma, my husband and I are considering surrogacy or adoption to grow our family.  But I think almost daily  About how much I would love to give birth to another baby. Yet I am absolutely petrified.  Can you offer me any information on the chance of me experiencing the same complications?  Doctors have told me I'm very likely to have another hemmorage and will definitely rebreak my coccyx. Would a c-section be safer for me in the event that I would need to have my uterus removed. Would a c-section keep me from breaking my coccyx?  I am a lactation educator and believe surgical birth can have very negative consequences for the nursing dyad, so it's hard for me to consider it, but I'm very concerned that I won't be able to care for my two children if I break my coccyx again and also have anemia from hemmoraging. I also sometimes fear that another hemmorage could result in death. Finally, the psychological aspect of all this concerns my husband and I.  Will I be so terrified during a pregnancy that it will harm my fetus? Is being pregnant a psychologically risky endeavor for my whole family? Your thoughts and guidance are greatly appreciated.
    Henci Goer

    I am so sorry that you have had such a difficult birth. As I understand your post, your concerns fall into two categories: one having to do with potential effects of its emotional aftermath on a subsequent pregnancy and labor and the other having to do with its potential physical effects.

    Starting with the physical effects, if the doctors you have consulted don't fall into this category, I suggest you ask around your community to try and locate an obstetrician whose philosophy and practices are supportive of physiologic birth and who only resorts to medical intervention when lesser measures have failed. That way, you can trust this person's judgment and recommendations. Your midwife might have some names as may the doulas in your area, or there may be a birth resource center or a birth network group where you live. If you are in the U.S., you can also try the Birth Survey, a kind of Yelp for care providers. Once you have found such a person, make a consultation appointment. Bring a copy of your medical records for the doctor to review.  I recommend writing down ahead of time your questions and concerns about the likelihood of problems in a future pregnancy and labor. Take notes on the answers during the appointment so that you will have them to mull over, and you won't forget anything. You may also wish to explore further why you haven't restarted menstruating and whether that could affect your ability to conceive. I'm not a doctor or midwife, but it seems to me that menstruation should have started up again by now even if you are still breastfeeding.

    As for the emotional aftermath, again, I'm not a doctor or midwife, but it seems likely that you are, quite understandably, suffering from childbirth-related Post-Traumatic Stress Disorder. PTSD can develop when people undergo an experience in which they feel powerless to control what is happening and are in fear for their life or the life of someone they love. This certainly describes what happened to you. In fact, it is quite possible that it describes your husband as well. There are effective treatments for PTSD, although it isn't always easy to find a therapist knowledgeable about birth-related PTSD, and whether you decide to try for another pregnancy or not, you may wish to look into this. At the very least, I recommend Solace for Mothers, an internet peer support group for women healing from traumatic birth.

    I wish you complete healing, both emotional and physical.

    ~ Henci 


    All Times America/New_York

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