Oxytocin injection for placental delivery

(97 Posts)
CoteDAzur Tue 10-Mar-09 21:14:23

I found out today that our hospital is undergoing a six month trial where every woman is given an oxytocin injection before delivery of placenta.

I kind of remember that routine injection of oxytocin without even waiting to see if placenta will be delivered on its own is A Bad Thing, but can't remember why.

Can anyone help? I have a meeting with doctor tomorrow and would appreciate some pointers as to how I should argue my case - a scientific way of saying "I'm not your guinea pig and you are not pumping me with hormones for no good reason".

Tangle Tue 10-Mar-09 21:36:24

Oxytocin is given to encourage the uterus to contract down and release the placenta. Syntocinon (which is combined oxytocin with "something else" - sorry) has the added effect of causing the cervix to close. Syntocinon has been implicated in cases of retained placenta - once you've given the drug you're on a stopwatch to get the placenta out, and that is often considered to be a Bad Thing. My understanding is that oxytocin in isolation has much less potential for bad side effects - its a synthetic version of the hormones your body releases when you and your baby initiate breast feeding, just a higher quicker dose.

Re. how to argue your case, the bottom line is that if they give you an intervention without your consent you can classify it as assault and sue! They cannot forcibly inject their patients against their will without facing some serious legal consequences. I'd ask them why they think its a good thing to give to all women, what the side effects are likely to be and whether there are any other risks. I'd then politely decline a managed 3rd stage (unless their arguments were extremely convincing) unless there were problems that necessitated a change in plan - you don't need to give a reason.

Good luck tomorrow

LynetteScavo Tue 10-Mar-09 21:40:21

I thought it was done every where as routine any way. (It certainly seems to be in my local hostpital)

You really don't need any reason for refusing oxytocin, and you certainly shouldn't have to argue your case. shock

CoteDAzur Tue 10-Mar-09 21:44:35

Much argument needed. You don't know French hospitals sad

SoupDragon Tue 10-Mar-09 21:47:10

State that if they inject you against your wishes you will sue them. Can you sue them in France?

CoteDAzur Tue 10-Mar-09 21:50:59

Well, I'm actually in Monaco - French doctors, nurses, and midwives and definitely the French mindset ("shut up and put up") but a separate country.

It is not a democracy. I don't rate my chances of suing the only hospital of the Principality as particularly high.

Tangle Tue 10-Mar-09 21:52:57

Not so sure what the deal is in France but I'd have thought it must still be a human rights issue (and its after the birth, so they can't argue that you may not like it but its in the best interests of the baby). Is there any kind of advice you could contact before your appointment? I'm wary of suggesting a way forward without knowing more about the legal situation.

Fingers crossed you can find a solution.

BoffinMum Tue 10-Mar-09 21:55:26

You also bleed longer overall if you accept the injection. That may be a minor factor, however.

Re: litigation. Where this is difficult there is always the media ....

BoffinMum Tue 10-Mar-09 21:56:46

Infant mortality in Monaco 5 per 000
Infant mortality in France 3.33 per 000


SnowlightMcKenzie Tue 10-Mar-09 21:56:53

Tell them, if they stick a needle in you, you'll stick one in them!

Tangle Tue 10-Mar-09 22:03:21

I would say threatening to sue is a bit of a last resort, as its unlikely to go down well! However, you can make it very clear in advance that you, as a patient, do not accept this treatment, that if they give it to you anyway you'll consider it abuse, and that you are aware of your legal right to refuse treatment (assuming it exists - and its a very dangerous precedent for it not to. But I guess ultimately that's the question that needs to be answered).

If its a clinical trial, surely there has to be informed consent?

Points to consider:

1) your aim is not to get into a situation where you have to sue, just to make them realise that you won't take the injection voluntarily - leading to there being major repercussions afterwards, either legal or bad publicity or both.

2) the case would be appealed to the European Courts if you did not agree with the decision locally. As a European citizen you have a right of appeal.

franke Tue 10-Mar-09 22:05:18

What a horrible thing to be faced with. I don't know how you feel about Michel Odent but he wrote about the third stage here and there's a good discussion here. Both good for background info. which may help you to argue your case.

me23 Tue 10-Mar-09 22:12:53

syntocinion isn't combined with anything it is synethtic oxytocin the same drug that is used to augment labour. It is normally used inthe 3rd stage if the woman is hypertensive.

syntometrine is combined syntocinon and ergometrine, which causes the cervix to clamp down and is useful in controlling bleeding, ergometrine can be given on its on but this will be if the woman is having a pph and bleeding needs to be managed.

Have you had other children if so did you have a natural 3rd stage with them.
nobodt should do anyting against your will. In the hopstials I know active management of the 3rd stage is very common.

CoteDAzur Tue 10-Mar-09 22:22:58

I have a DD aged 3.7. I'm not sure exactly what happened during delivery of her placenta, except that my head dropped back like lead at some point and I couldn't stand up on my own for about a week afterwards - so must have hemorrhaged quite a bit. I don't think I had oxytocin added to my drip, but it may well have been.

CoteDAzur Tue 10-Mar-09 22:28:27

Does anyone know whether routine oxytocin injection in anticipation of placental deliver is a bad thing for sure?

BoffinMum Tue 10-Mar-09 22:35:04
BoffinMum Tue 10-Mar-09 22:39:43

Cochrane review suggests active management of third stage and hospitals go hand in hand.

Cochrane review

morningpaper Tue 10-Mar-09 22:44:24

My midwife tried to make me have a 'natural' third stage

It SUCKED, she was making me stand up and crouch and I kept saying "PLEASE GIVE ME THE INJECTION I JUST WANT TO SIT DOWN WITH MY BABY" and she kept saying "Please give it five more minutes!"

I know some people are anti management of third stage but there is no way I would want it done 'naturally' - I've done enough work by then, I just want to look at my baby thanks while someone else deals with that end...

morningpaper Tue 10-Mar-09 22:47:44

Cote AFAIK the third stage is managed to prevent excessive blood loss and haemorrhage which used to be common before the injections became routine

BoffinMum Tue 10-Mar-09 22:48:56

Natural third stage is actually quite boring, I agree!! But avoids the risk of retention of the placenta and subsequent surgery. Plus postnatally the bleeding is over and done with more quickly.

morningpaper Tue 10-Mar-09 22:49:50

is that true of a managed third stage with just oxytocin?

I need references

BoffinMum Tue 10-Mar-09 22:50:38

Cote, bearing in mind how medicalised your hospital is supposed to be, I might be tempted to go along with the injection, tbh. Do you really want another battle at the moment??? It is not the worst thing they can do to you IMO (on the other hand automatic stirrups is).

Never thought I'd say that!!

morningpaper Tue 10-Mar-09 22:51:52

I would have it like a shot

If I had a hippy midwife again I would stick the needle in my arse myself

SnowlightMcKenzie Tue 10-Mar-09 22:52:56

Cote You might want to think about accepting for this reason.....

I chose a 'natural' 3rd stage with a mw who wasn't very experienced at it. The consequence was, being made to lie on my back whilst she tugged and tugged for 20mins causing me to bleed heavily.

She then told me that it was taking far to long and that I was bleeding too heavily for her to allow it to contine so she got me to agree to the injection. Only then did she allow me off of the bed and onto the birthing stool where the placenta fell out instantly before she could tug, and the splash covered her in blood. (he he)

And this was in a MLU birthing unit.

I suppose what I am trying to say is, that if you don't do what they consider the norm, then it may get handled wrongly or badly.

The result for me was a pph. The MW would say it was BECAUSE I went for a natural 3rd stage. I would say it's because she tugged on the cord when she shouldn't have done in a natural 3rd stage.

Something to think about anyway!

BoffinMum Tue 10-Mar-09 22:53:06

MP from my brief incursion into the Cochrane literature and so on I got the impression that syntometrine and oxytocin are comparable for outcomes with a slight leaning towards syntometrine but also increased side effects. Check out the Cochrane database for more info.

morningpaper Tue 10-Mar-09 22:54:25

I've never seen a coherent argument about this

I don't understand the enthusiasm for an unmanaged third stage

I want persuading

BoffinMum Tue 10-Mar-09 22:54:36

Um, natural third stage takes a good half hour or thereabouts, does it not?

WTF was she pulling on the cord for???

BoffinMum Tue 10-Mar-09 22:57:27


Pro natural third stage - Avoids risk of retained placenta and subsequent surgery and associated risks.

Anti natural third stage - Avoids risk of PPH.

Hospitals could deal with either situation OK, IMO.

morningpaper Tue 10-Mar-09 22:58:44

statistically, what is the risk of retained placenta?

KingCanuteIAm Tue 10-Mar-09 22:59:43

I had the injection with each of my children and, despite very fast labours, I took a very long time to deliver the placenta. Each time came dangerously close to going to theatre and had to miss the precious early moments with midwifes practically swinging off the cord <boak>. My second delivery I had retained products as a result and had to go for a D&C a week after birth - with a new baby I couldn't bf because I was so ill by then.

With the last labour I questioned my midwife who told me it was a "well known side effect of the injection coupled with fast labours and could drastically increase the danger of heavy bleeding and retained placenta. (Apparently not one midwife at any of my other births had heard this - or cared enough to apply the information to me angry).

With my last labour I had no injection and the placenta was delivered very easily - just like the baby and only took about 20 minutes with minimal bleeding.

AFAIK the injection works well for the majority of women which is why it is used as standard in most hospitals - in fact most women are not even aware of it unless they read their notes and see the midwife has ticked the "patient agreed to injection after delivery" box hmm. However, in the few kinds of labour which are outside the norm it can cause problems itself or make problems worse.

My honest advice for anyone would be to ask to try a natural 3rd stage with the understanding that you will discuss an injection should it become necessary. However I was told that it worked best given quickly after delivery (and women are less likely to argue at the point!).

As for your arguments for your doctor, I can't help much other than to give you my experience - I hope it is of some use to you?

SnowlightMcKenzie Tue 10-Mar-09 23:01:57

'WTF was she pulling on the cord for??'

I don't know. She was the 'expert', I was just a complying patient (that time)!!

(2nd time was a natural 3rd stage whilst bfing in a pool, with the cord cut after placenta delivery.)

electra Tue 10-Mar-09 23:03:44

shock How awful for you to have to put up with a system like that!

I had the injection during my first experience of childbirth. The hospital staff admitted they felt it may well be responsible for the hemorrhage I had afterwards. Apart from this, it made me very sick. I had had an epidural, couldn't get up to be sick -- it was hell.

DaisyMooSteiner Tue 10-Mar-09 23:04:19

Syntometrine can also have nasty side effects MP, like headaches and vomiting - not much fun when you're trying to enjoy your new baby.

My personal view is that syntometrine is great to have on standby if you have risk factors like a long labour, previous PPH etc etc but it seems a bit of a shame to use it indiscriminately for every woman regardless of whether she bleeds heavily or not considering that it comes with its own set of risks.

electra Tue 10-Mar-09 23:06:05

I also had massive clots afterwards. The second time I had physiological third stage, and very little bleeding afterwards...

SnowlightMcKenzie Tue 10-Mar-09 23:06:17

Thing is DaisyMoo that the silly mw caused my pph, so the next time I had had a previous pph, so they were recommending the injection hmm

KingCanuteIAm Tue 10-Mar-09 23:09:34

Oh, Electra - I hadn't connected clots with the injection until you said that! I had huge clots with my first and third labours but none at all (well apart from the usual tiny ones) after my last! I wonder if it is the same thing - it would certainly make sense. Those clots were an awfully frightening experience after I had my first child - I was very young and had no idea what was normal or not!

electra Tue 10-Mar-09 23:12:06

Me too! I was 21 at the time and I remember sitting in the bath and thinking WTF??

BoffinMum Tue 10-Mar-09 23:13:22

0.1% without the injection in the west.
Can't find satisfactory data for with the injection - it's getting a bit late and I am tired. I might look tomorrow. It's likely to be higher though.

electra Tue 10-Mar-09 23:14:45

I was not asked if I wanted the injection and was not in a position to speak at the time it was given. I would want to avoid that again!

KingCanuteIAm Tue 10-Mar-09 23:18:34

I called the hospital (I was 19) I was so upset they told me to "bring it in". My thoughts were going from my womb had fallen out to I had delivered an undeveloped and unnoticed twin hmm (I was young blush).

Of course I took it in (in a taxi, with 2 babies [I was looking after my 6 mo niece that afternoon], in tears....) the mw took one glance and said "oh that's nothing" and went in her merry way. I could merrily have killed her at that stage grin

BoffinMum Tue 10-Mar-09 23:24:08

That's so sensitive of them, King Canute.

KingCanuteIAm Tue 10-Mar-09 23:29:44

Yes, I was really impressed with the MWs I met in my first hospital stay grin

I hope you get the information you need Cote. I do think it is wrong to administer drugs without information and choice.

CoteDAzur Wed 11-Mar-09 10:12:31

morningpaper - re "I don't understand the enthusiasm for an unmanaged third stage"

Mine isn't an enthusiasm for anything, just a strong desire to avoid the repetition of DD's birth where I wasn't told anything, nor asked for my approval on a variety of interventions, and ended up in agony for weeks.

Now that I have found that there is a policy of routine oxytocin injection for placental delivery at our hospital, for a six month trial period hmm no less, I would like to know (1) whether this is necessary, (2) if it has potential side effects, and (3) why not leave nature take its course?

morningpaper Wed 11-Mar-09 10:19:49

Hi Cote, I wasn't directing my confusion at you, I just wanted the position to be EXPLAINED (will read the thread in detail shortly)

I wonder if they are using oxytocin for six months INSTEAD of syntometrine? I.e. using the drug with less side effects - but perhaps it was always managed anyway?

DaisyMooSteiner Wed 11-Mar-09 10:23:49

Yes, it might well be that MP. I know that our local maternity hospital recently switched to routine syntocinon (ie oxytocin) instead of routine syntometrine. They changed back sharpish when the PPH rate went through the roof shock.

spinspinsugar Wed 11-Mar-09 10:39:58

It may have already been mentioned here, but oxytocin injection blocks the natural release of hormones during 3rd stage and after the birth. So essentially, the buzzy feeling one is supposed to experience after giving birth is removed, or at least reduced. One could argue this hampers mother-baby bonding. I really regret not having experienced this with dd (she had such an incredible labour too), I had to have a managed 3rd stage because of previous pph.

However, I think the most powerful argument you have is that you have a basic right for a completely natural labour if that is what you desire and all things being well.

susie100 Wed 11-Mar-09 10:42:56

I think site gives an interesting pro and cons list (it is for homebirth but can be apllied to any setting)


I think as soon as there has been ANY intervention (waters broken, drugs) then a managed third stage is recommended. In a birth with no intervention, there is no reason to have a manged third stage but this means NOT TOUCHING the placenta, not having a good old pull (shudder!)

In hospital it is very unlikely you will have no intervention at all as that includes

Clement Wed 11-Mar-09 10:46:54

i asked not to have injection. midwife thought i was bonkers. didn't have it anyway, she was keen on respecting my rights. third stage took one hour of constant trembling and shaking and pain and moving from bed to loo to bed while a student proffered my still-attached baby in front of me like an offering. i kind of wished id had it.

PinkTulips Wed 11-Mar-09 10:54:41

it's routine over here to the point that the mw i had with ds1 had rarely done it without and the student mw who was in her final year had never seen a physiological third stage.

when i had ds2 a few weeks ago the doctor who was discharging me couldn't understand the concept at all... kept asking the mw 'but she has not had the medicine, but you always give the medicine, no?' and told me i could bleed to death without it hmm (african doctor, he did turn out to be quite nice but his english was abrupt to say the least)

at the end of the day though it's your body and your choice,... they cannot force you to be injected with artificial hormones if you don't want to be so stick your guns and simply refuse.

CoteDAzur Wed 11-Mar-09 10:56:50

Is there really a high rate of PPH without the oxytocin injection?

How on earth did human race survive until its invention?

PinkTulips Wed 11-Mar-09 11:06:42

also.... with dd i had the injection (unwanted but was jabbed while watching dd be resussitated and was too late to argue at that point!)

with her i had a pph requiring a drip and more drugs and i had a small chunk of retained placenta (passed naturally 3 days later so thankfully avoided surgery). i bled heavily (very heavily) for 5 weeks, trailed off by 6 weeks

with ds1 i was up and walking 10 mins after the placenta came out and bleeding had practically stopped by 2.5 weeks, although had light brown blood until 6 weeks

with ds2 i walked myself to the maternity ward right after the placenta delivered and again bleeding died down over a week ago, still need panty liners but it's not bleeding as such. ds2 is 4 weeks old.

duchesse Wed 11-Mar-09 11:18:35

If you have the jab and you have a bit of retained placenta, you are in a worse situation than if you had let nature take its course as the jab causes the cervix to clamp shut, thereby trapping anything left behind. I've had one managed (against my will, was also jabbed despite not giving my consent) ad two physiological third stages. Had the most bleeding with the manage one. Estimated blood after third labour was 100 ml- ie little more than a period. (in fact I've had heavier periods)

duchesse Wed 11-Mar-09 11:22:48

btw- pulling on the cord is potentially lethal in itself! Only necessary if patient has been given the jab and birth attendant worried about whole placenta being stuck inside clamped shut cervix.

A friend once had a 7 hour 3 rd stage with her third child, during which tie the cord carried on pulsating. Basically while the baby has not yet started breathing reliably the cord and placenta carry on working.

I could go on. Can you tell I'm rather sold on physiological 3rd stages?

duchesse Wed 11-Mar-09 11:26:01

Clement- the student probably wanted you to hold the baby and breastfeed it to help your uterus contract! B/f releases natural oxytocins.

All three of my third stages, whether managed or unmanaged, have taken less than 5 minutes and were unnoticeable in terms of pain or contractions. The physiological ones were the quickest.

morningpaper Wed 11-Mar-09 11:29:34

I don't understand that duchesse - what would have happened then if the cord had been cut when the baby was delivered?

Why is the cord cutting delayed for a physiological third stage?

N.B. I have recently read a fascinating book about a midwife in the eastend of London in the 1950s and she talks a lot about post-partum haemorages and how they were common until the oxtocin injection

CoteDAzur Wed 11-Mar-09 11:30:55

duchesse - Please go on. Three hours until my appointment with doctor.

morningpaper Wed 11-Mar-09 11:31:27

There just doesn't seem to be enough INFORMATION about this in terms of statistics

I don't see how anyone on their first birth is supposed to make an informed choice about this issue

morningpaper Wed 11-Mar-09 11:32:50

.... becuase some people are saying 'I'd rather have it naturally!' and others are saying 'NO way, it was awful!' - so how are you supposed to know which category you fall into?

And surely, in this case, all other things notwithstanding, there has to be ONE approach which is the most sensible?

But why would that NOT be the approach that NICE recommends?

Ineedmorechocolatenow Wed 11-Mar-09 11:34:50

I had the injection after instrumental delivery and doctor bloody abseiling off the cord hmm and had to go back in a week later with a womb infection, IV antibiotics and some bloody awful clots coming out....

Not sure I'll have it again when I have DS2 in May/June....

CoteDAzur Wed 11-Mar-09 11:34:54

Is it only syntometrine that clamps cervix shut or does oxytocin have this effect as well?

duchesse Wed 11-Mar-09 11:39:03

morning paper- east end 1950s- very very poor area with a lot of malnutrition, bomb craters and inadequate housing, overcrowding, disease and people barely out of rationing. Need I say more about risky pregnancy.

Cote D'azur- you may struggle to get the concept around a french doctor! If you've had no previous PPH, you'd have a good case for asking for it. The crucial thing is not to let them cut the baby's cord- that most of the point. Physiological management also evens out the amount of blood in the baby/vs placenta which cutting the minute it comes out does not. The point is that you do not need to cut the cord straight away if you haven't had the ergometrine.

Sorry, have to go out now, but google "physiological third stage" and you should find loads. Alternatively see if one of the MN midwives is about!

duchesse Wed 11-Mar-09 11:40:31

ps the placenta keeps working while the baby is not breathing properly. It's a miracle really- nature's safety net.

CoteDAzur Wed 11-Mar-09 11:49:26

morningpaper - re "there has to be ONE approach which is the most sensible? But why would that NOT be the approach that NICE recommends?"

What does NICE recommend? I don't know if it's the same thing the French staff at my hospital are doing.

To answer your question, though - Quite often, what is best for the herd differs from what is best for the individual. (I don't know if that is the case here - just trying to gather information)

Take cancer - What is best for individual is to get drugs that will best fight his cancer. However, NICE refuses to fund some of these drugs because they are expensive.

Take routine antibiotic post-episiotomy - What is best for individual is to take antibiotics so as to prevent a potential infection (quite likely, with a cut in an area that is impossible to keep clean). However, this is not best for the herd because routine use of antibiotics makes bacteria stronger.

CoteDAzur Wed 11-Mar-09 11:53:14

duchesse & others - When should cord be cut, then?

Tangle Wed 11-Mar-09 13:05:15

Cord is often cut when it stops pulsating, as this is taken as an indication that blood flow through it has ceased. Although some women will say a "completely" physiological 3rd stage means you don't cut the cord till after the placenta is delivered if you cut it at all (google "lotus birth" for that one), assuming its long enough to allow the baby to feed whilst still attached.

Sorry about the syntometrine/syntocinon confusion. Had a feeling I was doing something wrong while I was writing it blush

Thinking about it more, I do think its worth considering what experience of a physiological 3rd stage the MWs in the hospital have - as has been said, it can go very badly wrong if the only difference the MWs make is to not give you the injection.

Let us know how you get on

morningpaper Wed 11-Mar-09 13:18:01

I find this all a bit FRUSTRATING because it doesn't seem very evidence-based

standanddeliver Wed 11-Mar-09 13:22:51

Syntocinon isn't oxytocin - it's synthetic oxytocin and doesn't necessarily work in the body in the same way. I personally think we fiddle with normal birth at our peril - how do we know all the possible subtle sequelae of injecting a hefty dose of synthetic hormones into women at the moment of birth?

That said Cote, hospital birth is usually managed in such a way as to make pph more of a risk, and therefore a managed third stage makes sense.

And midwives who are unused to dealing with physiological 3rd stages can put mothers at risk by managing them inappropriately.

standanddeliver Wed 11-Mar-09 13:27:20

Morningpaper - IMO it's very difficult to find research which compares outcomes for managed vs physiological third stage in a meaningful way, basically because there are too many variables to take into account re: the labour itself. IMO many normal hospital practices (eg using pethidine which interferes with babies' normal suckling reflex), routine failure to ensure skin to skin contact after birth, liberal use of pain relieving medications and physiologically stupid positions for birth make an unmanaged third stage more problematic.

susie100 Wed 11-Mar-09 13:54:14

Morningpaper - there are some studies (abstracts of) this on the homebirth website I linked earlier on in the thread.

SnowlightMcKenzie Wed 11-Mar-09 14:13:47

Oh, this thread is making me cross.

My stupid mw made me have a pph, which led me being very anaemic. Consequently I found bfing very difficult in the early days and refused to feed on day 5. I heard my baby cry but didn't care, partly because of being so week, but now it turns out that I was also
robbed of my bonding hormone.

My DS spent the first year of his life being ignored and just tolerated. He now has speech delay.

Okay, not 'necessarily' all the midwife's fault, but........

TheProvincialLady Wed 11-Mar-09 14:52:32

MP I had the jab first time round and puked and puked for hours. I was quite keen to do it naturally with DS2 and had a lovely home water birth so it should have been brilliant, but actually my fanjo hurt and I was shattered and just wanted to go to bed so I asked half heartedly for the injection but it was too late by then. I eventually delivered it into our old washing up bowl. I think placentas are irritating things no matter how you get rid of them.

me23 Wed 11-Mar-09 15:53:44

syntocinon= synethetic oxytocin doesnt contain ergomentrine which is the drug that causes the cervix to clamp shut. Maybe the reason your hopstial is swithing from syntometrine to syntocinon is bevause it wants to reduce the risk of retained placenta?
As somebody saidbefore if you have had a normal labour with no interventions and no high risk of pph there is no reason that you shouldn't have a natural 3rd stage, However the midwives should be experienced in knowing what to look for i.e potential warning signs. (tbh all midwives recieve this information I've already been taught it in my training and I'm a first year!)

duchesse Wed 11-Mar-09 17:28:46

this is quite an interesting thread on a midwives' forum.

duchesse Wed 11-Mar-09 17:45:19

Also this one is quite interesting anecdotal study about a change in diet and massive increase in PPH among Indonesian women. Scroll down to "Hemorrhage in Asia"

CoteDAzur Wed 11-Mar-09 18:21:59

Snowlight - My experience with DD was similar - lost lots of blood, very weak, couldn't care less about DD in the initial weeks.

I thought that was because I was in so much pain that nothing else mattered, but now I think it may also have been because initial bonding was hampered? (No skin-to-skin, baby whisked away to be weighed etc then handed to my mum outside the door hmm)

AuldAlliance Wed 11-Mar-09 20:06:15

Cote, it just gets better and better doesn't it? hmm
Will ask DH if he can drum up legal info on patients' rights in Monaco, if you like, so you at least know if you can convincingly wield the suing argument or not.

Did you get the long, rambling and not-of-much-practical-use e-mail I sent you ages ago?

CoteDAzur Wed 11-Mar-09 20:39:15

Yes, indeed sad

Sorry I didn't see your mail until now. I don't check that address often.

I don't think anyone has ever successfully sued the Monegasque royal family government, so don't bother looking for legal angles. Thank you for the thought, though.

susie100 Wed 11-Mar-09 23:15:57

Duchesse - I had a feeling you wld link to the Radical Midwives site - I was obsessed with that sitge in pregnancy and found it very useful for EVIDENCE BASED research.

There are lots of wonderful entries from an indie midwife called Mary Cronk who is a bit of a legend (esp when it comes to normalisation of things like breech birth)

BoffinMum Thu 12-Mar-09 08:02:15

It's not the Monaco govt sticking the needle in you, it's a bunch of doctors doing a trial.

They are subject to controls of their professional association. They can't just go giving women injections because they feel like writing a paper on it. They need to have informed consent.

duchesse Thu 12-Mar-09 08:36:24

susie grin all this is starting me back on the dangerously obsessive birthing streak I thought I'd left behind ten years ago... Except that now I just take it for granted that I'll get a physiological 3r stage and all the other things I want. Advantage of being 40 something rather than in my twenties this time! Also my midwife is superlative.

duchesse Thu 12-Mar-09 08:36:47

-ly good I mean

susie100 Thu 12-Mar-09 09:45:09

Me too! I pregnant with number 2 and worried I now know TOO much grin

Sheeta Thu 12-Mar-09 09:50:23

Just to add - retained placenta is still possible, even if you don't have the injection. angry

about a 1/200 chance I believe

BoffinMum Thu 12-Mar-09 11:48:59

Sheeta, it's nearer 1 in 1000.
A tenth of the risk of having a general anaesthetic and dying.

I had to argue my case against the oxytocin injection several times during my labour hmm. One of the midwives filled up a needle and put it on the table next to me as I was pushing DD out and said 'well we'll put it there just in case'. In the end the other midwife had to say 'she doesn't want it'. My placenta came out with the next contraction.

I haven't read the whole thread (bad form I know)

After DD was born in a midwife unit, in the water, no pin relief, I encouraged not to have it - I had no realy strong feeling either way, I had achieved my natural birth (reather than the C sect my consultant wanted due to previously broken pelvis) so I was happy not to have it.
The midwife said, "You've just opushed a 9lb baby out, you'll have no trouble."

Came out, no reall issues - or so I thought.

30 mins after DD was born I was told to go to the loo, DH looked after DD and the midwives went off to 'do their rounds'. I can remeber feeling my arms go numb and shouting to DH "I'm passing out" which I duely did. I came around some while later on the bathroom floor in a pool of blood so large I couldn't reach 'dry ground'.

My uterus had not contracted and I was suffering a severe PPH. I was given the injection 60 mins after DD was born. I took ages for the bleeding to stop. (it is besides the point that they didn't transfer me, call a Dr, suggest I have a transfusion or iron tablets) I was too weak to walk for 48 hours (from someone who has finished a horse cross country course with a broken collar bone and no front teeth).

I was so ill for 24 with a raging fever and rigors. I passed fist and bigger sized clots for days and bled heavily for several weeks.

at 11 weeks post partum I went for an op to put right unstiched nearly 3rd degree tear, I pointed out to consultant that I had a bit of a wiff from down there. under GA he checked, I had retained placenta and had contracted GBS (which caused massive problems in my 2nd preg).

I was ill for monthes and exhausted and found it hard to care for my DD.

If only I'd had the injection straight away, as I hadn't had any objection to it before the midwife intervened.

BoffinMum Thu 12-Mar-09 13:40:22

shock MarmadukeScarlet!!!

I may be wrong, but I thought they should be able to feel with their hands after the birth that the uterus had not contracted. They also should have examined the placenta to make sure it was intact, which it clearly can't have been.

It sounds like if you think you have a hospital mw, then an injection is the way to go, as they may be so deskilled at managing natural third stage that they could do real harm (like the swinging on the cord thing someone described earlier).

Sheeta Thu 12-Mar-09 13:40:37

BoffinMum thanks for that - our NCT teacher told me the wrong info then.

1 in 1000 eh? Now that makes me feel really special.

BoffinMum Thu 12-Mar-09 13:43:40

I looked it up last night before conking out, could backtrack to the reference if you like, but I think it was based on something like WHO data or mainstream gold standard stuff like that. However NCT teachers also talk sense so she may have been referring to the local area or something like that.

Of course stats are meaningless without context, so things like environment, maternal age, nutrition, labour management and probably even something daft like the cycle of the moon all play a part in these things.

susie100 Thu 12-Mar-09 16:19:41

Boffinmum - I agree entirely. It is very sad that hospital midwives are becoming deskilled in many traditional techniques like a natural third stage, breach birth (ironically now is incredibly dangerous in hospital cos no one knows how to deal with in and starts fiddling rather keeping the hands off the breach!)

it then becomes a viscious cycle where the concept of risk in childbirth gets totally skewed. Sigh.

BoffinMum Thu 12-Mar-09 20:55:42

I would have thought the whole point of being a mw would be to be a kind of consultant for normal birth, including VB of twins, breech deliveries, that kind of thing. However they appear in some cases to have been turned into obstetric handmaidens. sad

Biccy Thu 12-Mar-09 21:06:12

I apologise as I have only read the start of this thread, but I would find out what will happen if you don't have the injection - as in how long they will give you to deliver the placenta and what will happen if you don't do it within that time. I didn't have the injection, naively believing that if it didn't work naturally I would then get the injection - but no, fortunately I did deliver it after 55 minutes (and the help of a marvellous midwife), but had I reached 60 minutes I was told it would have been an epidural and straight to theatre with me... which would have been very annoying having done the whole birth with not so much as gas and air. If I'd known that was the sequence on refusing the injection, I don't think I'd have rised it, and think I will probably opt for it next time (assuming there is a next time).

But, surely they can't force you?

Boffinmum, but these weren't 'hospital' midwives it was a midwife only unit with no Obs consutlant or other medical staff - so surely should be skilled at 'normal' birth?

BoffinMum Fri 13-Mar-09 07:56:27

Perhaps it has something to do with a redefinition of what 'normal' birth is?

Many people would not see breech as 'normal', for example.

BoffinMum Fri 13-Mar-09 07:56:29

Perhaps it has something to do with a redefinition of what 'normal' birth is?

Many people would not see breech as 'normal', for example.

SnowlightMcKenzie Fri 13-Mar-09 17:06:29

Marmaduke My midwife only unit birth had the mw swinging from the cord during a natural 3rd stage. I also wasn't allowed to be upright until I agreed to the injection (due to risk of pph hmm).

It's quite shock tbh.

me23 Fri 13-Mar-09 19:46:02

it is shocking! In lectures today we were told of some research a midwife did where she had scenarios concerning what active 3rd stage is and what physiological 3rd stage is and only 25% of the midwives in the unit got it right shock she said us first years are already a lot more clued up about 3rd stage then quite a few midiwves out there.

3rd stage is the most risky time of labour for the woman so it does need to be done with skilled people in attendence. For people considering physiological 3rd stage (which is the way nature intended and allows the baby to receive all the blood it is meant to) should ask their hospital what is the percentage of these.

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