Delivery of placenta - confused!

[sarah00001]

Hi, I've been asked to put together my birth plan. I need to decide if I want to have physiological third stage of labour or active third stage. From what I've read it seems that active third stage is often preferred by hospitals but I want to do what's best for the baby at the end of the day. I just wondered what other people are opting for, as I can't decide!.

Thanks, Sarah

[ItsNotAsPerfectAsItSeems]

For my first, I had the injection as I didn't know any different. For my second I made clear that I wanted a completely natural 3rd stage. Hospital were fine with it as quick easy delivery. But it took over an hour with labour pains to boot. 3rd&4th times I went for no injection until after the cord had stopped pulsating. Then jab and cut cord. I read a lot of the research and apparently the greatest benefit is whilst the cord is still pulsating. Baby 3 it took around 5mins to stop, baby 4 a little less. Thus was a good compromise for me.

[BananaPie]

The placenta is no longer attached to the baby when you deliver it. The injection makes it come out much quicker - I went with that both times.

[OhEmGeee]

First time I didn't have the injection as I wanted to deliver the placenta naturally. However it didn't come out and I bled. I then had to have the injection to remove it.

Second time they gave me the injection because of what happened the first time and it came out. I bled anyway.

Not that I'm trying to scare you, there's no predicting what will happen. But delayed cord clamping is recommended currently. We did that with DC1.

[ItsNotAsPerfectAsItSeems]

BananaPie, it is if you opt for a co
Plate physiological 3rd stage which is what the op is considering and what I opted for 2nd time around. Babies 3&4, I went for a compromise.

[Elledouble]

I didn't have the jab and the midwife just tugged on the cord after cutting it and it came it dead easily - I think I was expecting to have to push it out, it was all simple.

[scrivette]

I said that I was happy to have the injection but in the Midwife led Maternity Unit I was on they prefer not to give it initially, so I didn't have it and didn't have any problems.

[funchum8am]

Also be aware that even with the jab it might not emerge! I had to have a manual removal of placenta with dc2, even after the jab. It was painless as done under spinal block but annoying to have to have surgery after giving birth with only g&a and having to be away from baby so soon.

[ItsNotAsPerfectAsItSeems]

Yes, even with jab, it may still be a struggle or you could not have the jab and deliver the placenta within a couple of minutes.

[SweetAndFullOfGrace]

You may want to take the rest of the birth into account and have some options thought through.

Delivery of the placenta depends on the release of hormones to start to contract your womb (plus some women just have issues with it detaching so there is a physiology component).

If you have a relatively intervention free birth followed by skin on skin contact with the baby and breastfeeding then it may plop out easily and quickly (mine did).

But it isn't always that straightforward and birth interventions or trauma can make the natural process of expelling it less effective hence the injection can be a good option. As a pp said the delayed cord clamping is the most important part for the baby.

[pinkie87]

Sorry to hijack, but regarding delayed cord clamping, who do I tell/ask that I want that? I suppose I can tell my midwife and she will write it in my notes? Will that always be adhered to or do I also have to tell midwives during delivery? Just worried I may forget in the middle of everything! i'm currently 29 weeks.

[sycamore54321]

Third stage has next to nothing to do with the baby. It is about maternal safety.. Hospitals don't just "prefer" active management because it is quicker, they recommend it because it significantly reduces the chance of you having a serious haemorrhage and bleeding out within minutes. When the placenta comes away, the placental artery is supposed to be sealed by the contracting action of the womb - if that does not happen correctly, you basically have an artery pumping your blood volume unchecked into the uterine cavity. It can kill you, very quickly indeed. It is a leading cause of death in childbirth.

I know I sound awful but I am not saying this to frighten you, just to state the facts. Obviously it is entirely your choice to analyse this risk and discuss with your healthcare providers and decide whether or not to consent to active management but you should be clear that the reason medical staff propose it is not convenience or time but the very important question of your safety.

[Velvetbee]

I refused the injection the first couple of births, then sat on a toilet trying to deliver the placenta whilst other people got to know my lovely new baby. Ended up with the injection both times anyway. So even if you opt for physiological it might not work out that way.

[Christelle2207]

I wanted a natural third stage first time but I ended up with a hemorrhage (sp), all very panicky, then had manual extraction of placenta.

Second time I had the injection and it was all rather less stressful.

Don't doubt that there are benefits to letting everything happen naturally but there are risks too.

[Christelle2207]

Pinkie
Do remind the MWs in labour. However they will likely ask you at some point between contractions.

[LillyBugg]

I didn't have the injection and delivered my placenta within about five minutes (from what I remember). I have since read on here that some people think that a natural third stage can lead to more painful after pains. Whether or not this is true I don't know but my after pains were horrendous. I'll definitely be looking into this more for the next baby when we get there. Just to add another problem to the mix...

[Chips1999]

I wanted a physiological 3rd stage with DS but I got bored of waiting after 45 minutes of sitting on a potty! I had the injection and my MW said that they give you an hour and then would prefer you to have the injection if it hasn't come out in that time.

I don't actually remember the 3rd stage with DD, she was born very fast. I think they cut the cord straight away and I probably had an injection. Will ask DH! I was shaking for a good while afterwards, the MW said it was just adrenaline.

[Athenaviolet]

My last birth started off physiological- but when the placenta didn't come out after a while (half an hour?) the midwives got all worried and gave me the jag. But then it still didn't come out. Although imo that was because they were stressing me out because they wouldn't let me get vertical or move about. One of them actually pushed me back down flat onto the bed. How the hell is it going to come out uphill?? I wasn't bleeding but they started to treat it as an emergency because almost an hour had passed by then. They told me I'd have to have surgery! But of course as soon as I stood up it fell out onto the floor. It was a really traumatising mess after the easiest birth possible!

[fanjodisfunction]

I had the injection with my first but after it hadn't come away for some time. it still didn't come away so had to have it taken out during an operation, in which they usually give you and epidural but this didn't work so I had to be given a general.

second time it wasn't going to come away either so had the injection again but thankfully it came away. I'm so glad it did as recovering after the first took awhile.

I'm pregnant again and this time I'm going to try and stand and see if that helps it along. I do not want the op again.

[sarah00001]

Thanks everyone for your advice. It sounds to me like the injection might be the best option. xx

[ItsNotAsPerfectAsItSeems]

Sarah, why not consider what I did for. 2 of mine and what others are also advocating? That is, don't have the injection as baby comes out (because if you do, the cord needs clamping and cutting immediately) Instead, let the cord stop pulsating, then have the injection and clamp and cut. There is lots of evidence that this is really beneficial to baby and it doesn't put you in a position of waiting for an hour or possibly haemorrhaging.

[ragged]

I found this article this morning in favour of at least partial physiological stage, quite pleased with my own choice.

[fanjodisfunction]

I am going to delay the cord cutting this time round, and see what happens. I think it is best for baby that way. I'm hoping that third time round I shall be more vocal and also know what I want in labour.

[NickyEds]

Itsnotas I'm thinking of doing this with dd (35 weeks), waiting for the pulsating to stop and then clamping, cutting and injection (just had injection straight away with ds). Did it have any effect that you know of on after pains. I'm really quite scared of after pains at the moment? Were your hospital happy to do it?

[ItsNotAsPerfectAsItSeems]

I'm not sure. My after pains got worse with each baby and I think that's normal. I had them each time I BF for the first 24hours or so. I didn't have any at all with my first and then quite bad with my second, not too bad with my third but fairly painful with my fourth to the extent that I was back on the G&A.

[CloserToFiftyThanTwenty]

I think the key with any birth plan is not to see it as fixed in stone and be prepared to go with the situation. Eg I originally said I didn't want the jab, but after delivering a teeny prem baby who was going to need SCBU I just wanted to get labour done and out of the way, and the jab is generally the quickest way to do that