Midwifery Today Community

 Hi Ladies, had a Grav 8 come on the books yesterday, a devout muslim lady, 4 hospital gynae births, 2 previous home births, one late miss. Wanting a home birth an hour away. Every other midwife in the surrounding area refused her due to grand mulitparity, its very very unusual to to have a grav 5 here,never mind a Grav8! Am just looking fo any advice /tips from you wise women out there. We are prepared for a PPH, although this mum is only 34yo, and in really good health with no history of PPH with any of the others, her labours go as follows: very mild short irregular cntx (often an hr apart with big gaps ofime in between runs of cntx, never any show or SROM, then 10min of hard cntx and birth of the baby) am flying a little in the dark here i will be honest, other than PPH and missing the birth is there anything i should watch out for?

Thanks so much for the help

Watch out for the experience of a great birth!

I love grand multi's, they are fun births.  I just had a mama yesterday who had #5 at home with me, Second homebirth with me, a vbac too, other than kids trailing in to see the new baby and requesting food or misplaced items,  it should go really smoothly.

After pains are strong, have some arnica (or something stronger) at the ready.

 Not necessarily a watch out but depending on the culture of origin of your Muslimah you may need to consider...

~hubby may want no part of the birth experience

~in the event of an emergency transfer be sure you back up is a female physician

~make yourself aware of any products personal and clinical that may contain pork and/ or non halal ( similiar to kosher) animal derivatives

~I'm a G6P5 and definately experienced some severe PPH and excrutiating pain pospartum. Surely it didn't help that my younngest two are only 54 weeks apart.

~Depending on her history of interpartum length and interest in knowing, have a plan for Natural Family Planning education, that's truely natural and realistically doable (lifestyle friendly)

~potentially a dlay in naming

~ getting an INVITE to a BABY Naming/ SHOWER- 1 week postpartum with lots of people and sooo much love and fun... and if you are invited you really need to go, REALLY!

 All my grand multips are Mennonite women, so my experience may be different.  I've never had a PPH with a grand multip, so I wouldn't worry any more about that than with other women.  Long latent phase (sometimes days) seems to be common followed by a fast active phase.  My ladies seem to have more anxiety and worry in the weeks leading up to the birth.  I haven't seen the severe afterpains with my grand multips specifically.  Just 2 weeks ago I attended a 45 y.o. G 13 P 12.  She said it was one of her easiest.  My Birth Assistant is due in April for number 14.  She put it very clearly, "I have my own way of doing things."  That being said, I've found my grand multips still like more than the average amount of guidance from their midwife.  This surprised me.  When I asked one lady, a G 9 P 8,  at the 6 wk. PP check, "Anything you would have me do differently next time?"  She said, "I want you to tell me what to do."  This might, of course, be specific to the Mennonite population. One of my favorite grand multip stories was of a 41 y.o. G 9 P 8.  During my 36 wk. pre-labor discussion she asked, "Why don't I ever get pushing pains?"  I said, "You don't wait long enough."  She decided she was going to wait this time.  It was a truly rewarding experience to see this woman experience her first "pushing pain" 30 minutes after I told her she was 10 cms.  Then, to see her utter shock when her water broke on its own 10 minutes after that...followed by the birth of her baby after only one voluntary push when her baby was crowning.  She said, "That didn't hurt at all.  It always burns, but not this time."  I share this with all my ladies, telling them.  "This could be your best birth ever!" 

I am a grand multip.  I had 5 children in the hospital and 6 at home after that.  Each one got better, IMO.   I really couldn't tell that having so many caused more problems.  I did feel odd after the last two were born, like my organs weren't falling into place as quickly as they used to....  LOL  I was diligent with the last ones to take excellent care of myself, including drinking tons of RRL tea with nettles.  I didn't even have afterpains with the last one, which shocked me.  

 I don't know why midwives would be scared of a G8 lady, I did 3 G 10's last year (all Mennonite), and have done G-11 &12's too! I don't recall any of them having a pph. By the time you have that many, you know how important a diet high in green leafy's is to preventing pph. As someone already said, many have a prodromal "warning" then spit the kid out pretty fast! So don't wait to long to go! The older the mom, regardless of how many times she's been pregnant, the greater the chance of Downs... one of my grandmultips last yr had a Downs baby, the 1st Downs for me, and her community, but she was 40, your lady is only 34, so chances are minimal for that with her. I do have to warn some of my Amish to slow down and try to leave more space between babies, if you're getting up into the double digits with less than 2 -3 yrs between, it is easier for moms reserves to get depleted. Then she is more likely to hemorrhage. So make sure her diet is not lacking!  I remind my Amish that breastfeeding is part of God's plan, bottles & paci's aren't. That way I am pointing out that it is part of our natural design to space kids 2-3 yrs apart, and it is unnatural to have a baby every year!  Then I go into total breastfeeding, and NFP.  And they do "slow down" once they get my lecture. Of course some few people do get pregnant in spite of their best efforts not to, but most can use bf & NFP to space out their babies to healthy intervals.