I am about to have my 3rd VBAC at my midwife's cottage in the next week or so.  I have had 2 successful VBACs in hospitals (last one was able to labor in tub) and enjoyed both those experiences.  However we have moved to a new location and the hospital here is not so understanding of wanting a natural VBAC so we were lucky enough to find our wonderful midwife who has a birthing cottage set up with an amazing tub!

My only concern is about post partum care.  I have had alot of bleeding postpartum which concerns me wether it is a good idea to stay there after the birth.  She also only has regular beds and not so sure about how comfortable that will be for recovery, especially while breastfeeding; love those hospital beds. 

We are considering going to the hospital soon after birth for postpartum care.  Due to my husband's insurance I've been able to be seen by the midwife group attached to the hospital and have a good repore with them.  I'm wondering if it would be a good idea to just show up at the hospital with baby, not letting them know all along we had planned a 'homebirth' and receive care for recovery there.  Or am I just over worrying?  Any suggestions would be appreciated! 

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I bled quite a bit with both deliveries, one at the hospital and one at home.  Ask your midwife if she can leave you with a pill that you will use if the bleeding continues to be heavy.  I never needed it but it was nice to know it was there.

I bled quite a bit with both births. 1st in hospital, 2nd in home. I am red-headed and I guess we usually bleed more than other people. Anyway - I never even thought about going to the hospital after my 2nd birth. I wanted to be home, in my element, able to relax.


If you feel like you are comfortable going to the hospital after your baby is born, then go ahead. I know that a lot of moms who choose alternative birth places usually do not want to be in a hospital at all.  Maybe wait and see how everything goes, and if your midwife thinks you are bleeding too much,  you can decide then to make the trip to the hospital. They don't need to know why you chose the birth place you did, but they will help you with your post-pardum bleeding.

IMHO (not trying to sound harsh, condecending or discouraging) if you are that concerned (and I can certainly understand why you would be) about PPH, you might seriously rethink your decision to do an OOH birth...even the strongest supporters of HB/OOHB consider total trust in the process & your MW to be part of what it takes to consider that as an option. If you are worried about the after...it could seriously affect the NOW. Unresolved fears/worries have a HUGE impact on labor & if this is a big enough issue for you too consider leaving the cottage & going to the hosp, esp if you are also worried/wondering about how the hosp might react when you arrive w/baby, it may very well hamper your ability to feel safe, relaxed, & allow your self to let go...which in turn would affect your labor progress.


Was your bleeding just really heavy or was it diagnosed as PPH? Was your previous bleeding so bad that it required intervention not available to you at the cottage? At what point PP did they/you discover you were bleeding heavily/hemmorraging? Has your current MW looked over your previous birth records, which includes info about the bleeding? Does she feel like it is going to be a possible issue and that PP transfer for bleeding may be necessary? (I would imagine that if you have a history of PPH your MW would seriously consider this in her decision to recommend for or risk you out of an OOHB) Are you worried that once you are home your bleeding will get severe?  


There are herbs that your MW can give you to take at home that are effective at helping heavy bleeding. Maybe your MW will allow you to stay at the cottage longer than normal so that you feel more comfortable when you do go home? Does she do PP visits the next day? Maybe sch your 12 hours later instead of 24 so your bleeding can be evaluated (this might make you feel better & safer). Discuss this issue w/your MW. Tell her your fears. If you trust her to be your provider in your OOHB, her feelings on the necessity of you going to the hosp for PP care should weigh heavily in your decision.


 Since you haven't had the OOHB...there are great advantages to L&D OOH, but there are also great advantages to what happens to the baby after he/she is here...As for the hosp bed being more comfy/easier to nurse in...I had lots of fluffy pillows to prop up on, and best of all, the bed was big enough so that Daddy, my son, & daughter & I all got to snuggle in our bed w/the baby...as a family. Def not an option in the hosp bed. Plus when night came & it was time to sleep Daddy wasn't forced to sleep in the hosp uncomf cot/chair thing (that was his FAV part about the HB, as he snuggled up to me & the baby that 1st nite in bed he told me this was the greatest idea I ever had :-)

In the end you have to gather all the info you can & then make the decision that feels best for you...

I have birthed in the hospital and at home and have to say I greatly prefer recovering in my own bed, where no one wakes me up (except the baby), no one disturbs me or the baby, and I can eat/drink whenever I want/need to.  For our homebirth, some ladies brought food for us every other day for the first two weeks.  And we stocked up on easy to prepare (microwaveable stuff, fruit and fresh veggies) so we would have plenty to snack on w/o stressing about food prep.  Being out of the hospital was so much more relaxing for me!  Also, I wore what was comfortable (or didn't wear anything but a robe when I felt like it, sry if that's tmi! lol).  I hope I never have to birth in the hospital or recover in a hospital again!  It was a night and day difference!

First, were your VBACs in a hospital? Midwife tended or OB tended?


The reason I ask is because natural labors tend to bleed a little more postpartum (from my first-hand experience & second-hand witnessed births) than labors that are augmented with pitocin. This is reasonable, because most induced or augmented labors are "topped off" at the end with a final shot of pit to expel the placenta and clamp the uterus. Just as natural labor contractions are more manageable than pit contractions, pit contractions are quicker at clamping bleeding postpartum. It is a reasonable conclusion, there. I mention this, because nurses may "feel" as if you're bleeding heavier than others would, because it is heavier than what they usually see. Unless it is diagnosed hemorrhage, I wouldn't worry too much about it.


The bleeding isn't a bad thing, though, unless it is just overwhelming...filling a pad an hour possibly with clots for a significantly long time.


If you are worried about postpartum hemorrhage, you should be in a hospital. Immediate hemorrhage requires immediate medical attention and is usually what is associated with partial or complete uterine rupture. Delayed hemorrhage has plenty of signs & symptoms that will tell you if you need to go to the emergency room...fever, bleeding through 1 or more pads an hour for 12 hours (even after resting), pain, passing lots of clots, etc. It is usually caused by poor suturing to wounds from the birth or retained placenta, I think. Your midwife can help to make sure that you've not retained placental tissue by thoroughly inspecting the placenta after the birth. Also, you could request that it be placed in a bag and put into a cooler for you to keep. If you aren't feeling really great and suspect bleeding within 24 hours of the birth, you can take this with you to the hospital to help them decide whether or not you've retained placenta. That would be up to you.


Your midwife will have herbals (if a lay midwife) or pitocin (IV or oral, if a nurse midwife) to care for immediate bleeding issues.  If she doesn't...I might suggest a different midwife. Make sure that you are taking your prenatals, getting a good amount of Vitamin K and iron, and are well-hydrated during the weeks before birth.


Basically, if it was me, I would avoid going to the hospital unless medically necessary to do so. Read as much obstetrics and midwifery literature in the prevention, treatment, and signs and symptoms of postpartum hemorrhage. That will be your best resource in battling postpartum bleeding.



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