MW has told me syntometrin injection for 3rd stage prevents retained placenta? T or F?

[susiesheep2]

At my last appointment I said could I leave the syntomtrin injection and only use it if their seems to be a lot of blood, as previously i have reacted to the injection with really high BP - 190/130 (usually I have low bp, always around 110/50) as last time the last midwife did say the high BP is a side affect of the injection, it did fade after half an hour, but there was a big fuss about my high BP and I felt quite spaced out / shocked (could have just been the quick birth).

Anyway, my new midwife has said the injection is needed because sometimes the cervixs closes before the placenta comes out and it will get trapped and id have to go to hospital (booked for home birth as with previous).

I thought the injection increases the risk of retained placenta as it makes everything clamp down quicker.

I also said part of the reason I didnt want the injection was because I didnt want to cut the cord straight away and leave it to stop pulsating. Although she has said you can still do this with the injection and I am sure I have read somewhere you should not do the injection with cord still attached because it pushes too much blood to baby. Really confused now!

Should I be worried about the high BP side effect or not, anyone know? Its so frustrating when you feel you are only getting told things they agree with and not the hold truth about things :/

[lostintransition]

You're midwfe is wrong about syntometrine preventing retained placenta and you are right- it's what causes the cervix to clamp down before the placenta comes out sometimes. If you've not had a previous high blood loss in the 3rd stage, I would forget the injection all together and go for a physiological 3rd stage instead.

You could request that if there is a concern about bleeding that you receive syntocinon instead of syntometrine as it is associated with less side effects and it does not contain ergometrine which syntometrine does and causes the vomitting, high BP and also responsible for contracting the cervix. This would need writing up by a doctor ad you would probably have to get it yourself as the midwives probably won't carry it routinely.

The idea that leaving the cord intact after the injection shunts to much blood to the baby has only ever been a theoretical risk, I read some research recently (can't find it at the mo) that it makes no difference in blood volume when cord left intact.

Obviously if your haemmoraging syntometrine would probably be a good idea and also you would need a transfer but thats very unlikely. Hope you enjoy your homebirth!

[PrincessScrumpy]

I'm sure I was told that the reason for the injection was to ensure the placenta came out quickly after baby's birth. It was 3 years ago though so I can't remember.

[LoveBeingAtHomeOnMyOwn]

I thought it was to help contract meaning it comes out much quicker and less likely to retain. But I also thought if having the injection then you havebto cut the cord.

[Tangle]

My understanding is that syntocinon causes the uterus to contract - either to induce/augment labour or during the 3rd stage. In the 3rd stage those augmented contractions will cause the site where the placenta attaches to shrink faster than it would otherwise do and so the placenta should detach faster than in a physiological 3rd stage.

Including ergometrine into the injection increases the effectiveness of the syntocinon, and also causes the cervix to contract back. To all intents an purposes, once ergometrine is injected a timer starts ticking and, IIRC, there are only about 10 minutes to deliver the placenta before the cervix will be too tight to allow it to pass out easily - if the placenta is not delivered before this point then a trip to theatre will become necessary.

In general, I understood that a retained placenta was more likely if syntometrine was given, due to the effect of ergometrine on the cervix. I also understood that however unpleasant a hospital transfer might be (and I had to have one after birthing DD1 at home - it wouldn't put me off planning another HB), transfer for a retained placenta wasn't generally considered an emergency necessitating sirens and flashing blue lights...

I haven't come across much research re. the timing of the injection vs. cord clamping - but general practice seems to be that the cord should be clamped before the injection is given. It might be illuminating to ask this MW for the references to support her statements re. both the use of ergometrine and retained placenta and the timing of injection vs. cord clamping...

I'd go with lostintranslation's plan of phsyiological 3rd stage with syntocinon on hand in case of PPH. (Oh - and you don't need a reason to decline a managed 3rd stage, or any other intervention. You're a mentally competent adult - you get to make your own mind up )

[idlevice]

My friend who had a home birth in Kent had a retained placenta & it was an emergency transfer to hospital. She had the placenta removed manually without a GA or epidural as they said there wasn't time & it was pretty hideous. There may of course been other subtleties to the case that made it urgent.

I had a retained placenta after having had syntocinon during labour & the injection after. It was reported that my uterus was well contracted so maybe it was the cervix - I hadn't heard about that before. I remember being stabbed with the needle in the thigh for the third stage without being asked, not that I would have cared at that point from a physiological point of view but common courtesy wouldn't have gone amiss!

[LoveBeingAtHomeOnMyOwn]

Also my understanding is that a 'managed' 3rd stage is mainly for the benefit of being quicker. Taking up to 15 mins and can include the mw pulling on the cord. A natural 3rd stage could be up to an hour.

If you are having a homebirth I think you will stage more chance of less pressure to have the injection IMO.

Make your decision and add to you birth plan and make sure your birthing partner is aware. How likely is it that your mw will be the mw that appears on the day

[nunnie]

I had a retained placenta with my first, mine was attatched to scar tissue (not accreta) so it didn't detatch from the lining of the womb. I questioned whether it was worth trying without the injection for number 2 and was told by Consultant due to where and why my placenta retained then the injection would have had no bearing on this and would in fact delay the theatre move if the placenta retained again.
DS was born by EMCS so never got to find out if the placenta detached without MR.
Am pregnant again and planning VBAC and intending to take previous Consultant advice re injection for this one won't know for a few weeks yet if it works out well or not.

[susiesheep2]

::owww so confused now:: why is my midwife saying its to stop a retained placenta when general consensous is that it increases the risk.

If birth is day time 9-5 she will be there, if not it will be someone else as my CMW only works days. I didnt have her last time.

All I am really bothered about is baby being given straight to me, cord not being cut too quickly, and not having to be transferred to hospital for a retained placenta (or my BP going crazy), do I sound like i am just finding things to dwell over now?!! :S

as lostintranslation said, id rather just wait and see how the bleeding goes...

Can you have the injection afterwards (ie not immediately) if the placenta doesnt show up or i start to bleed to much? or does it have to be right away, CMW said it had to be as the shoulders where being born....

[MrsJRT]

You can have it at any point.

[JarethTheGoblinKing]

I had it about 15 mins after DS was born as it wasn't shifting by itself. As it was I had a retained placenta anyway and had to go for a MROP

Sorry, that wasn't spectacularly helpful.

I think if I was in the situation again I'd still go for a natural third stage, with the jab if things weren't moving after a while. (incidentally, I read afterwards that if the placenta is refusing to budge then catheterising can help move things along)

[citymonkey]

When I spoke to my consultant on Monday, I mentioned this briefly and he said that the injection isn't to speed things up, but to limit bleeding. Obviously a side effect of this is that the injection causes the bits inside to contract (thus stopping the bleeding) more quickly.

[Zimbah]

You can have the injection at any time. At DD2's recent birth I had asked for delayed cord clamping and physiological 3rd stage unless medically necessary not to. Baby lay on me for a while (don't know how long - a few minutes?) while the midwife waited for the cord to stop pulsating. However she then said I was bleeding too much, so she clamped the cord, gave me the injection and pulled out the placenta.

[YourMIL]

I had the injection, they ended up pulling on the cord when it didn't come out (my uterus had gone atonic from a precipitous labour) and although they thought they got it all out, two weeks later I spent 3 nights in hospital on IV antibiotics after it turned out I did have retained products after all. Midwives I have spoken to since said they personally don't recommend the injection for women who have fast labours for this very reason.

My next two DCs were c-sections so it wasn't an issue.

[FutureNannyOgg]

All the reading I have done suggests the jab increases the chance of retained placenta, from the cervix closing, and also the fast-contracting uterus can sometimes "pinch" of a section of placenta so a small piece is left behind. The jab is useful for speeding things up (but then, were you planning on going anywhere?) and reducing blood loss in PPH.
If you do bleed, or get bored waiting, you can always ask for it, but if you don't want it given automatically, you need to make that clear, as often they just assume you will have it.

[eaglewings]

Don't know all the facts but with DS I had the injection what seemed hours after birth as nothing was happening, all then went fine
With DD I had home water birth and no injection, can't rememebering it even being offered
Refused ergotomine with the first.

[EggyAllenPoe]

well, whatever you decide write it clearly in your notes and make sure the MW attending is clear about what you want.

too many women on here seem to have it given unconsented

[EggyAllenPoe]

..and last time i gave birth, they got my consent for the jab in advance but only in event of PPH.