Once a bleeder, always a bleeder???

Does the fact that a woman haemorrhaged during one child delivery make it “more” likely that it will happen again during subsequent deliveries?
My wife was due to give birth in Feb of 2009.  She went one week past her due date and the doctor induced labour using some cream/gel, then unsuccessfully  tried to physically to break her water, then finally added a drug to her I.V.  The contractions started and labour lasted about 10-12 hours and a couple of pushes later my son was born.  Everything seemed to be going fine but then the delivery doctor noticed my wife was still bleeding.  They took her out of the delivery room and informed me they needed to do a minor surgery to stop the bleeding.  For the next 4 hour nobody gave me any information until finally the delivery doctor came to see me.  She told me that my wife had almost died (in fact they had to resuscitate her at one point) and that she was being transferred to the Intensive Care Unit.  She spent about a week in the ICU and was given multiple blood transfusions then eventually recovered and wife and baby were okay.   The doctors later told us that they are not sure what caused the haemorrhaged.
My wife is now pregnant for the second time and due April 10th.  Her O.B originally had recommended a C-section but now has changed his mind and prefers she deliver vaginally.   Should I insist on a C-section???  It is the same O.B this time around and he has made notes in her file and insists he and the hospital will take extra precaution this time around but stops short in actually telling us what those precautions are.  
A second opinion would be greatly appreciated.  Also any woman who have gone through similar experience, please share your stories and what you opted to do for the 2nd child.

[Elaine Brown, MD]

Hi!
I am so glad that you have a healthy family! It sounds like you almost lost your wife! If I were you and your wife, I would insist on knowing what precautions/measures are being taken to safeguard your wife this time around.  I would also strongly consider requesting her records and having them reviewed by a second party for a second opinion about delivery options.  Because I am as much in the dark as you are about the cause of the hemorrhage, it is difficult for me to answer your question ( and it is a VERY IMPORTANT QUESTION!) about the recurrence risk.  Honestly, I would feel uncomfortable in the situation that you are in with your doctor giving you so little information.  I would search for another doctor who can and will communicate better with you about what happened last time and what he/she is going to do to prevent it this time.

One example -- if your wife had a placenta accreta, I would strongly consider c-section this time around.  If your wife had a cervical laceration or sulcus tear that hemorrhaged, a vaginal delivery should be relatively safe.

Get more information if you can!
Good luck!
Dr B

[starshine36]

I'm no doctor but.... with my 1st little boy I lost a
Of blood.... no one listened when 4 hours later I was bleeding quite abit  and couldn't stand up...felt dizzy etc..... luckily my body clotted its self and after 6 hours lost 3 blood clots and felt much better
But then they wanted to give me a blood transfusion... I refused and went with iron tablets..but it took me 10 days to finally feel better.... with
My 2nd son..... the hospital was well aware of what
Had happen at my 1st labour and did what ever!
Needed to do to stop me bleeding.... it worked
Because I was up and about and discharged within
2 hours and giving birth.  

[smeesmum]

Induction vastly increases the risk of PPH (the bleeding your wife suffered). The artificial hormones work the uterus so hard that once the baby is out the uterus is weak and exhausted and cannot contract effectively to stem bleeding. In addition the drugs they use to stop bleeding are the same as those they use to induce, and the uterus can stop responding to them after a long induction meaning a bleed is harder to stop.
Bloodloss over 500mls after a vaginal birth is considered excessive, but 600mls bloodloss is considered normal after a section (you bleed a lot more during a csection than a normal birth). Placenta accreta, where the placenta is growing into the uterus is very rare and is almost exclusively a symptom of past csection or other uterine surgery (the placenta adheres incorrectly at the site of the old scar). Your wife would have had chemotherapy following delivery if she had accreta. In any case csection cannot save you from it and in fact increases the risk for future pregnancies.
To minimise the risk of bleeding your wife should avoid induction, and do not consent to augmentation (drugs to "speed things up"). Unless the baby is actually showing signs of distress induction only causes problems, increases pain, increases the risks of morbidity and the risks of intervention yet does not improve maternal or neonatal outcomes. It helps medical staff schedule their week and keeps women moving through L&D timeously. As you know yourself some of those women move through L&D and into ICU.