Bleeding in pregnancy is always worrying. The conventional advice to women on discovering that they are bleeding is to call a doctor and immediately go to bed, or, if the bleeding is heavy, to call an ambulance. However, there are various reasons why some women prefer not to do this.
Firstly, for some women, especially those for whom it is not their first pregnancy, bleeding seems to be relatively normal. For example a small survey of women suffering from endometriosis, a common condition where uterine tissue grows outside the uterus, found that as many as 50 per cent experienced bleeding in pregnancy, sometimes on and off throughout the pregnancy. Although they may not feel happy about it, they may feel that they can cope with it and would rather manage at home than be hospitalised.
Other women feel that, even if they are miscarrying, they would rather miscarry in the comfort of their own home, for many of the same reasons that they were choosing to have their babies at home. Women who have previously had hospital treatment for miscarriage often opt to stay at home if it happens again. This is not least because of the insensitivity with which miscarriage is sometimes treated by hospital staff.
The other point about consulting a doctor for lesser degrees of bleeding is that, apart from recommending bed rest, there is very little in the way of treatment. Moreover there is often an assumption that once you have been admitted to hospital at any point during the course of pregnancy, the delivery is automatically going to take place there. It is a great pity if you feel that you cannot admit to having problems because it will mean you are now no longer able to choose the place of delivery (although, of course, you still have the right to insist). However, if women are under pressure to have a hospital birth, reporting mild bleeding, for example, can feel like throwing in the towel completely. Feeling like this can make you very isolated, so you may be helped by some guidelines on bleeding in pregnancy. Your instinct for self-preservation is unlikely to let you down by failing to make you aware when it is really essential to get medical help.
You should contact a doctor or midwife if:
— You would feel happier in hospital.
— Bleeding is severe and/or accompanied by pain, particularly one-sided pain in the early weeks, or a rigid abdomen in later weeks.
— You have painless, bright red bleeding in the later weeks and you have not had a scan to show placental position.
What they can do:
— Advise bed rest. You may get more real rest in hospital depending on your circumstances, but you will probably feel happier at home.
— Do an ultrasonic scan to establish where the placenta is and if the fetus is alive.
— If miscarriage has become inevitable, give ergometrine to stop severe bleeding and perform an ERPC under general anaesthetic.
— Induce labor if the baby has died but labor has not started naturally.
But there are things you can do to help yourself:
— Go to bed and rest, lying on your left side to increase the blood flow to the placenta. Make sure that you are eating well, and avoid anything containing caffeine (coffee, chocolate, cola), alcohol and smoking. Accept as much help as possible, particularly if you feel you cannot rest. Rest has not been proved to prevent miscarriage, and plenty of women who have experienced bleeding in pregnancy have given birth to healthy babies. However, you may feel happier if you do rest, and perhaps have the consolation that you did alt you could, should you go on to lose the baby.
— Consider alternative remedies. An alternative practitioner such as an acupuncturist, herbalist or homeopath may very well be able to offer you treatment to stop the bleeding, whatever the cause. Alternative medicine has a far greater scope than Western medicine and has specific remedies for problems such as this, where there is no orthodox equivalent. An acupuncturist would treat you twice within 24-36 hours and perhaps give you moxa (a slow burning herb) to use at home to warm specific acupuncture points. He or she might also advise you about diet and rest. This treatment would be effective unless the baby was damaged, in which case the miscarriage would continue. Herbalists or homeopaths would provide herbs or pills specifically for you and the cause of your bleeding.
— Try increasing your vitamin intake. The following have been suggested as helpful in stemming bleeding in pregnancy: Vitamin E — up to 2,000 iu daily. Zinc — 25 mg daily. Manganese chloride or amino-chelate — 10-20 mg daily. Essential fatty acids — 1-4 g evening primrose oil daily.
— If you cannot reach an alternative practitioner, you might want to try taking any of the following herbal remedies: False unicorn root (Helonias or Chamaelirum luteum) — 15 g to a pint (600 ml) of water, boiled and then simmered gently for 15 minutes. Drink freely throughout the day. Alternatively try 20-30 drops of the tincture, three times a day. Wild yam root — take 50-120 ml of decoction, prepared in the same way as the False Unicorn root, every half hour. You could also try a 50:50 combination of the tinctures of Chamaelirium luteum and Viburnum prunifolium. Take 10-20 drops in a little cold water every 15-60 minutes until the bleeding stops, gradually reducing to 20 drops each morning until 22 weeks.
— Avoid intercourse for two weeks after the bleeding has ceased. If the bleeding followed intercourse, it may have been caused by cervical polyps or erosions. It can be helpful to ask if these appear to be present if you have a routine vaginal examination.
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