# Fibroids, PPH and home birth



## helenO (Sep 22, 2006)

Hi    Sorry in advance for the long essay!! Writing it all down has really helped me to figure it out in my head, but I'd really like your opinion on whether I've missed anything, or misinterpreted the risks.

I've decided I would like to give birth at home if at all possible. When I first spoke to my community midwife she was supportive, but asked me to talk it over with the doctors at the ante-natal clinic because I have a number of fibroids.  However, at my last appointment she said she had spoken to her supervisor who 'wasn't happy' that I should have a homebirth because it's my first baby and because I have fibroids.  I'm very upset by this, but I believe its ultimately my decision where to give birth - so I feel like I need to think it over carefully and decide whether there really is a good reason to go for a hospital birth. Of course I want to do what's best for the baby, and if I try a homebirth but it doesn't work out for whatever reason and I have to transfer to hospital that's fine, but I'd be very disappointed to not even try to have the baby at home for no good reason.

I'm not concerned by trying for a homebirth for my first baby, in fact I think it's more important for a first birth, but I would like to understand a bit more about the risks associated with fibroids so I can make an informed decision. From what I understand, after a lot of Googling, fibroids are relatively common (about 25% of white women have them, and a lot have them without ever realising it), and they can cause two main complications in labour: blocking the birth canal, and heavy bleeding afterwards (PPH).  

My fibroids are fairly small (the biggest is 4cmx4cmx2cm), and although I have a few none of them are in a position to block the birth canal.  At my last ANC appointment the doctor actually said to me that she couldn't get excited about them!  So I don't think that should be a reason to go straight to hospital. If labour just doesn't progress, then I can transfer to hospital at that point.

The only research I can find suggests that large fibroids increase the risk of PPH to about 8% (from an average of 2.5%). The explanation seems to be that they can stop the uterus from contracting back down effectively after labour, and the treatment for that is oxytocic drugs to help the uterus contract.  From what I understand it's standard for these drugs to be available at a homebirth anyway. Other treatment is to give IV fluids, uterine massage and possibly packing.  All of this can be done at home, and in fact before the latest bombshell my midwife had suggested a few precautions to take at home, such as putting in a venflon ready for IV fluids/drugs just in case. If it does all go wrong and I bleed heavily and it isn't stopped by the usual treatment, I live only 5 minutes drive to the nearest hospital, so I could be transferred quickly if necessary. If I needed surgery in the worst case scenario, the midwife could call ahead to get the medical staff/theatre ready. 

So... it seems to me that there is a slightly increased risk of PPH, and that the first line treatments to manage this would be available at home just as they would in hospital. Transfer to hospital should be relatively quick if it is needed. On balance, if all this is correct then I would stand my ground and try to have a homebirth.

But... my doula, who is a practising midwife herself, said that while she's not completely sure she thinks that the oxytocic drugs won't stop bleeding caused by fibroids. She isn't sure why this might be, but suggests that getting the uterus to contract back down isn't enough to stop fibroids bleeding.  Do you know anything about that?  I can't find anything online about the causes of PPH influenced by fibroids except the atonic uterus explanation.  Any more info to help me decide (and have my facts ready for the inevitable argument with the doctors!) would be really helpful.

Thanks for reading, sorry again for the long message! 

Helen
xxx


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## emilycaitlin (Mar 7, 2006)

Hi,

Having a home birth is completely up to you, you are right in that the biggest risk is a pph with fibroids.  When this happens, if you can't control the bleeding, things can deteriorate very quickly, and just be aware that although you live 5 minutes from the hospital, it would take longer than that to get you there, as the ambulance would need to come from the control centre, get you into the ambulance, get you to the hospital and they would then need to sort out anaesthetic and the other drugs that you need. 

I can't be sure, but there is also something in the back of my mind that oxytocics don't work with fibroids, but I can't check as I'm on maternity leave.

They don't sound to be too concerned about the size of your fibroids, so as long as you have all the information, are aware of the risks, and make an informed choice, you have the right to a home birth,

let me know how you get on with your cons,

emilycaitlin xx


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