After pains - do they get worst after each baby ?

[pupuce]

My cousin is expecting number 4 and is really delighted as she just found out that it's a girl (she has 3 boys!)... but she is genuinely worried about the after pains as they were really bad after baby number 3 (they were bad after baby number 2 too) but is it going to get even worst ?
What do you know and recommend ?
Thanks

[mears]

The likeliehood is that they will be worse but not always. With my 4th I wasn't given syntometrine for the third stage ( midwife got caught out and she forgot basically) and so I had a physiological third stage. The afterpains were much less than the previous 2 deliveries. I am sure that is because nature was taking it's course. Physiological third stage should only be done after intervention and opiate free labour.

Paracetamol is an overlooked medication and works quickly. It would be a good idea to take it at regular intervals for the first couple of days after delivery especially prior to breast feeding ( though obviously there needs to be 4-6 hours between doses).

Remember painful though they are they only last a couple of days on and off.

[sml]

I second the paracetamol suggestion. Must say though, I didn't have worse after pains for no 3 than for no 2.

[SueDonim]

My afterpains got worse with each baby, even though I had a physiological third stage with the last one. I guess there are as many diferent experiences as there are women.

[emilys]

sorry to be dumb - what is a physiological stage 3?

[SoupDragon]

Is it where you deliver the placenta naturally and not with the help of the injection?

[pupuce]

Yes it is where you do not get the injection.

[mears]

Sorry about that.

Most third stages ( delivery of the placenta) are actively managed in hosptital by giving an injection to the mum at the time the baby's shoulder is delivered.

The 2 usual injections are syntometrine ( syntocinon+ ergometrine) or syntocinon on it's own. They speed up the third stage and reduce bleeding. Unfortunately syntometrine can cause headache, vomiting and increase of blood pressure. Some places now just give syntocinon which does not have those side effects but is not as good at reducing blood loss.

However, nature can do it on it's own (physiological third stage) but it takes longer - up to 1 hour (or more) instead of approx 10-15mins. Should only be physiological if the rest of the labour has been - no intervention and no drugs.

Active management is so routine women do not expect anything else. Very interesting subject.

[leese]

Find the issue of delivery of the placenta really interesting. There was astudy done in Bristol a feww years ago (Bristol 3rd stage Trial), which suggested that a physiological third stage increased the likelihood of losing more blood post delivery, and possible post partum haemmorhage. however, after a little more delving, they had to render the trial innacurate, as it appeared too many midwives were mis managing the third stage.
Basically, a physiological third stage, as Mears says, means no injection, and let nature take its course. A 'managed' third stage is when the injection is given, the cord cut and clamped, and the placenta is delivered as the midwife pulls it out. In the trial however, midwives were so unused to letting nature take its course, they didn't quite know what to do. For example in some instances no injection was given (as per physiological approach), but the cord was still clamped immediately and cut when it should have been left. there were other mistakes made too, which rendered the whole thing unreliable.
As Mears notes, a physiological third stage should only be advised if the labour and delivery has been unproblematic and trouble free. Also in instances of 'precipitate' labour (ie extremely rapid), the injection may be advised

[lou33]

I think everyone is different so saying for sure that the afterpains will be worse can't be relied on. However mine have got worse after each birth, and I have to say that it felt like I was giving birth again with number 4, and that was despite having a natural physiological 3rd stage. All I could do was stay very still and remember the breathing exercises I did during labour. Sorry if this worries your friend!

[pupuce]

Lou 33 - did you take anything for the pain ?

Mears/Leese - I had a physiological 3rd stage when I delivered DD in water (like you said it was a straight forward birth - 2nd baby) - I delivered the placenta 15 minutes later.

As you know I am now "doulaying" and have seen 1 (in the 4 births) physiological 3 rd stage (also water birth of a first baby!) and for her as well we only had to wait max 20 minutes for the placenta - I know 2 cases don't make the rule but delivering a placenta physiologically does not necessarily take very long.

[MalmoMum]

I have found the discussions here very interesting. I have had so little after pain or indeed any much any related pain this time around.

I had got a good stock of paracetemol etc in expecting to be glad to have them around.

I was concerned before I had this birth as I knew a managed third stage was not available and niehter was gas and air. Managed third stage is kept for extreme circumstances. The placenta delivery was quite straightforward in the end and I hardly noticed it.

[mears]

Pupuce - you are quite right- it doesn't always take a long time. I have had experience of both short and long physiological third stages. I mentioned the longer time sometimes associated with third stage because it Can be normal to wait that length of time. That is possibly one of the reasons actively managed third stage is still encouraged - it won't tie up a labour suite bed

[emilys]

i was never given the option of a physiological stage 3 - did you guys stipulate it before all hell broke loose?! I had had a drug free labour - so could have had it, i think i might try this time as i am on a low intervention midwive only (hippy!) unit at a different hospital - so maybe they would be more up for allowing it.

I do remember the after pains - had never got to that section of my baby books as i was too busy re-reading about the actual birth, mine were BAAAD - i suddenly thought i was having twins, no one had noticed and the 2nd one was about to come out! If i remember rightly diesn't b/f bring them on

[pupuce]

Emilys- you can request a physilogical 3rd stage in your birth plan or mention it as you go into labour... the MW I am working with actually pro-actively suggests it (even if birth plan says they want the syntometrine) if she feels that the woman would benefit from it.
Having said that I don't think all of her colleagues make that same suggestion to be honest.

As for after pains and BF... well BF hepls with the contraction of the uterus so you can indeed have strong after pains when you BF... but what ever you do, your uterus WILL still contract so anyone can have painful after pains.

[SueDonim]

I heard about a physiological 3rd stage at NCT classes and as I've always loathed that injection and massaging of the stomach to get the placenta away, I decided to put it on my birth plan. I think it took about 20-30 minutes, although I can't really remember. I did lose a lot of blood, though I tend to be a 'bleeder' anyway, post partum!

[Bozza]

Really suedonim, to be honest the needle going in etc barely registered with me. it seemed so insignificant at the time.

[SueDonim]

Yeah, it's really weird, Bozza, that that particular jag gets to me. Even thinking about it now almost makes me want to heave. Yet I'm not needle-phobic, I have regular blood checks for a a thyroid condition and had to have a basketful of jags to come and live in Indonesia. I've no idea why the 3rd stage one affects me so much!!

[bluebear]

This thread has got me wondering- how do they remove the placenta in a c-section - do they just rip it out or do they give syntometrine and wait a bit before taking it out? Must admit I was too enthralled with ds to care at the time.

[leese]

bluebear - usually give the synto intravenously, so you wouldn't notice anyway - this encourages the uterus to contract, and the placenta to detach - you'll be heartened to hear it's not just ripped out!

[bluebear]

Thanks Leese - I couldn't remember an injection and I was certain that they wouldn't hang around waiting for things to happen naturally - forgot about the drip!

[bluebear]

Thanks Leese - I couldn't remember an injection and I was certain that they wouldn't hang around waiting for things to happen naturally - forgot about the drip!

[Lip]

My afterpains were worse with number 2 than number 3.

[fio2]

mine were worse with no.1 than no.2

[Lollypop]

After pains were worse with No2 than No1 but as I had read Mumsnet I was prepared with my paracetamol and microwave hotty bottle. They stopped after about 4 days but they were awful-like bad period pain.