The Placenta: physiological 3rd stage or injection?

(32 Posts)
LPplusOne Wed 16-Jan-13 17:48:22

I'm unsure of which way to go, as it seems there are clear pros and cons for both. Which did you choose and what would you choose if you were (or are) doing it again?

Wuxiapian Wed 16-Jan-13 18:42:04

I have no choice as I had a PPH with my first son 14 years ago. Although, I had the injection then, too...

In my situation, making sure I have a good iron level is crucial.

Bunbaker Wed 16-Jan-13 18:44:05

I had the injection, but didn't feel a thing - not the jab nor the placenta coming out. I had DD in my arms by then and everything was a bit of a blur by then.

crunchingicicles Wed 16-Jan-13 18:44:20

I chose physiological 3rd stage but with consent for a managed 3rd stage if it were necessary.

LPplusOne Wed 16-Jan-13 18:45:45

What was your experience crunch? (If you don't mind me being nosey...)

firsttimer01 Wed 16-Jan-13 18:50:06

I had the injection and will choose to have it again.

Flisspaps Wed 16-Jan-13 18:54:56

I had a PPH and retained placenta with DD.

I chose a physiological third stage when having DS as I wanted to reduce the chance of my placenta getting stuck behind the cervix and needing another manual removal. Unfortunately he was an forceps birth in the end, so I had to have a managed 3rd stage anyway - had a bigger sodding PPH this time though.

You can choose to have the jab after a while if you want to - it doesn't have to be given at the exact time of birth. The placenta can take up to an hour to detach naturally.

BanghamTheDirtyScone Wed 16-Jan-13 18:59:24

I had the synto, 2 weeks ago, with ds3 because I had a small PPH with ds2 (homebirth) and was afraid it would happen again.

LPplusOne Wed 16-Jan-13 19:05:07

Thank you Fliss - I was hoping this might be the case (re. physio then jab if going too slowly or painfully)

CrunchyFrog Wed 16-Jan-13 19:15:16

I had physiological with my youngest two, altogether a more pleasant experience.

DS1 it was minutes after birth, but with DS2 we also waited for the cord to stop pulsibg. It was about 25 mins.

You do have a choice Wux. I had a pph with my first but had a physiological 3rd stage with my next two.

I had the injection, but waited for the cord to stop pulsating first. Didn't feel any of it. Infact, I had to ask if they had given me it (was in my birth plan, buy couldn't remember it happening).

crunchingicicles Wed 16-Jan-13 21:06:17

1st time had epidural so they said it'd be better for me to have/had yo have injection (can't remember to be honest). 2nd time MWs weren't sure if I was possibly having a PPH & were busy helping my baby to start breathing with bag & mask whilst partner on phone to ambulance. So, kinda asked in a stating way if could give injection & I just nodded - we'd built up a good relationship & trusted them completely. They explained after that it may have been fine without but they wanted to concentrate more on my baby (all turned out fine & ambulance sent back smile after they'd finished cooing over newborn, haha).

crunchingicicles Wed 16-Jan-13 21:13:03

I'll be choosing same option - physiological but managed if it seems necessary. What was more important to me was delayed cord clamping, til cord finished pulsating, which MWs did with 2nd. And with that one I really appreciated seeing the placenta & sac, made it feel more complete for me. If you want that, make sure it's in birth plan, especially with a hospital birth or in case of transfer from homebirth, otherwise it's just discarded. Maybe take a container if you want to take it away.

PaleHousewifeOfCumbriaCounty Wed 16-Jan-13 21:16:48

My midwife told me that a natural third stage reduces afterpains, i gave it a go when I had my third baby 15wks ago and had no afterpains at all.

crunchingicicles Wed 16-Jan-13 21:19:31

Ooh, Pale, none at all?? Sounds good! Maybe this time it'll work out without injection.

rustybells Wed 16-Jan-13 21:19:44

I can remember pondering over this. Opted for the injection both times and it was the right decision for me - I wasn't aware of any of it, too busy cuddling my baby.

lollypopsicle Wed 16-Jan-13 22:04:44

I chose not to have the injection. The placenta took nearly an hour to pass and had to stagger to sit on the loo to get it moving (midwife advice). On the stagger back to the bed I had a big bleed. midwife gave me the injection anyway as it can help prevent further bleeding. I had no further bleeds. I'm glad I chose not to have the injection but may choose to this time round as I am worried about a big bleed again and planning on a home birth.

mayhew Wed 16-Jan-13 22:06:24

One downside not previously mentioned. Some women vomit when given syntometrine. Have a bowl handy.

Also: It has become custom and practice to give syntometrine immediately the baby delivers ( I was taught to do it as the first shoulder starts to deliver!). But this is not necessary unless haemorrhage is occurring at that moment. It can be given after the cord has stopped pulsating. It can also be given after the placenta has delivered. Its main protective effect is to stop the womb realxing in the first few hours after delivery where that would cause heavy bleeding.

I think immediate administration has remained popular because it allows the staff to physically pull the placenta out, which gives them a sense of security and control and also it shortens the whole process and feels like a timesaver.

Haemorrhage is very scary. I understand why doctors and midwives can be so wedded to a technique they believe is protective. However, the way its done "traditionally" is not the only way to practice safely. And there are downsides to all interventions including this one.

BanghamTheDirtyScone Thu 17-Jan-13 07:52:31

Now you mention it I thought I remembered us waiting for the cord to stop pulsing...I'm not entirely sure what we did tbh.

Can that be possible then - to wait for the cord to do its thing, then have the injection? All I remember clearly is that I was coughing and the mw said, you'll just cough it out at this rate - two more coughs and there it was. She thought it was hilarious. I had bronchitis at the time. smile Not a problem!

mayhew Thu 17-Jan-13 08:32:04

Coughing is a technique I use for a physiological delivery. Simples!

ThreeWheelsGood Thu 17-Jan-13 09:18:56

I put in my birth plan that I didn't want the injection, but in the end I'd been in labour for days, so the last thing I wanted was more waiting around! Had the jab - it stings - placenta delivered no problems not long later, stitches done, off to bed!

PaleHousewifeOfCumbriaCounty Thu 17-Jan-13 09:20:26

Theres definitely a big aspect of the staff wanting to retain control of the process. I had the natural third stage but the mw was flapping a bit and attempting some shady pulling on the cord. It took twenty minutes but i dont feel that was remotely excessive

TheTiger Thu 17-Jan-13 09:23:06

I had delayed cord clamping for 5 minutes, then had the injection. Placenta delivered within minutes, can't even remember what it felt like as was too wrapped up in this beautiful boy on my chest smile

TheTiger Thu 17-Jan-13 09:23:36

Also, had no after pains at all!

Me too Mayhew - grin

Last time it was all a bit of a mess. Placenta detached but membranes all tangled up inside me. Had to have a good fish around. MW was hopping about as she couldn't see what was going on with me being in the pool, but to her credit she asked me to explain what I could feel and gave me some guidance.

mayhew Thu 17-Jan-13 12:19:33

That reminds of a pool birth not long ago. "Here's another bit of membrane!" as she poked about her fanjango. I never even put any gloves on.

Admit it. That was me right? grin

squidkid Thu 17-Jan-13 17:51:49

I had a natural 3rd stage - it took a while (about an hour) and I had to push in the end and to be frank finding the energy to push at that stage was hard! They had to empty my bladder first, I couldn't wee by myself and apparently that might have been obstructing it. (I hope I remember that right, I was fairly out of it with exhaustion.) I heard the injection can make you a bit sick and you are more likely to have heavy bleeding for the next few weeks. i was at home for my birth so in no rush, I thought I'd see if it came out naturally, which it did.

squidkid Thu 17-Jan-13 17:52:32

ps. I did have pretty light bleeding post-birth - not sure if that is related or not. Only about 2 weeks, and lighter than a period except the first day.
I did have afterpains though.

mayhew Thu 17-Jan-13 19:58:10

Starlight: that would be spooky.

higgle Fri 18-Jan-13 14:47:06

I had a natural third stage with both my sons, at my request. It gave me time to adjust to it all being over, havea a little talk to DH and a cuddle with baby and then DH got to cut the cord, which is an important beginning of fatherhood ritual to us.

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