what are the reasons not to have the placenta expelling injection?

[RobynLou]

I've had 2 VBs and both times had the injection, first time just because, second time I haemmorrhaged so it was needed.
was taking to my friend who's pg with DC3 and doing antenatal yoga. the teacher keeps bringing up this injection and the fact that in her opinion you shouldn't have it.
we did nct together 1st time around and remember something being said about requesting not to have it then.
question is though, why is it considered a 'bad' thing to have? I'm pro natural birth and all, but once the baby was out I wasn't interested in waiting around for the placenta, I wanted it over and done with.
is there anything negative about having the injection other than the view that all intervention is unecessary unless it's vital?

[Pastabee]

Good post although i don't know the answer!

They mentioned this at my NCT breastfeeding classes as though it was a bad thing. I muttered to DH 'well I'm having it, I deserve a break after pushing the baby out'.

It seemed to be the view that you should leave cord attached and feed the baby to make the womb contract rather than using the injection.

Like you I think it's to do with it not being natural but in my book having the injection does not define a highly medicalised birth!

[meditrina]

I think the idea is that you don't need to artificially take over a function which the body will do perfectly well if left to its own devices. It means you stay on your own hormone control, not have injected ones disrupting it (but there is no evidence that it is harmful).

If you have had a previous PPH, then I'd say go for the jab TBH, as PPH carries risk of death. You don't really want high drama in the immediate post natal period.

If you have the jab, you can still make sure that your baby avoids the (potential, unproven) downside of precipitate 3rd stage by saying that you should not be given the jab until the baby is on the outside, the cord has stopped pulsing spontaneously and been clamped (ie placenta has delivered all it's going to, and none of the jab reaches the baby).

You can only have a physiological 3rd stage if you have had no pain relief in labour other than gas and air.

[seeker]

The idea is that the cord should remain attachd for as long asnpossible to ensure that the baby gets all the placental blood. I was insistent on not having it with my first, and it was only some years later that I realised that, as she was delivered with the cord round her neck and it had to be cut as she was being born that rather defeated the whole object of a natural 3rd stage!

[maxbear]

The main reason I chose not to have it was the fact that having it increases your risk of a spike in bp, a severe headache, severe afterpains and vomiting. Great for the baby to get the extra blood too, but I'm afraid my reasons were mainly selfish.

As another poster has said though only appropriate to go without if you have had a normal birth without any interventions that might increase your risk of a haemorrhage. It is usually advisable to have it in the event of having had a previous pph too.

[Josieannathe2nd]

Just to add a positive note- I was going to have the injection but after having a straightforward delivery the midwife suggested we just waited to see if the placenta came on its own. It didn't BUT while waiting for it I sat and cuddled my baby for 45 mins which was lovely - no checking for stitches etc, just nice peaceful cuddles. Once I got the injection the placenta came quickly so I think it's worth just waiting and seeing (if everthiing was straightforward and no PPH concerns) as it made the post delivery time lovely.

[Withwoman]

The questions should really be round the otherway. Is there any indication for the use of this drug.

If your labour has been drug free, and there no other concerns. It shouldn't be necessary.

However, if your labour has been medicalized in anyway, the the drug may be considered necessary.

The choice is yours.

[Woodifer]

if you cut the cord after it has stopped pulsating - you can then have the injection to expel the placenta, with minimum impact on blood transfer to baby.

i think the "no ttampering with own hormonal regulation" reason given above is the only one that makes sense as to why not to have it. You wil generally lose less blood and reduce risk of PPH, so i think i will go for it (after maybe waiting to cut cord).

[Bramshott]

I had it with DD1 and vomited, but not with DD2 and didn't vomit. That's a purely anecdotal vote from me!

[TheReturnoftheSmartArse]

Interesting you say that about the after pains, Maxbear. I had the injection with both my VBs. I nonetheless haemorrhaged a week later after the first and couldn't deliver the placenta with the first injection after the second birth so had another injection. The after pains were shocking!

Sorry, OP - I really don't have the answer but was just interested to read it!

[Stormwater]

I can't see the point of having a drug injected to do a natural function that my body would do anyway, seems unnecessary. As Withwoman said, you should say 'why' rather than 'why not'. I guess it makes a difference that I didn't have any other drugs with my two births, and I generally prefer not to take medication unless I have to.

[lovingthecoast]

I had it straight away with my first but only after the cord had stopped pulsating with 2 and 3 and not at all with No4.

The stuff I read when pg with DD1 (2nd) was that allowing the cord to stop pulsating would transfer all the placental nutrients into the baby. After the cord has stopped pulsating the benefits really transfer to you. Ive read that not having it helps to keep BP from rising and can lessen afterpains.

Anecdotally, my BP rose sharply after my first (with injection) and not with the others. However, my afterpains have got worse with each child so no benefit for me there.

[pootlebug]

I had it with my first....it seemed to be the done thing and I hadn't really researched why not tbh.

I didn't have it with my 2nd (home waterbirth). It took ages to get the placenta out. I had no energy left to push it out and felt like pushing on nothing. I missed out on time with my new baby trying to push the damn thing out for well over half an hour....thought I would have to go to hospital to shift it. Ended up losing much more blood than first time around and had to crawl to get anywhere for the next 3 days as was too dizzy to stand.

This time I'll ask for them to wait for the cord to stop pulsating then give me the injection.

[RobynLou]

interesting.
I get what you mean withwoman, I avoid medication as much as possible, had DD1 with g&a and tens and DD2 with just a tens, but there seems to be a lot of pushing against having the injection without any clear reasons against it, from this yoga teacher and the nct anyway. Just as I'm not a fan of people assuming you want the maximum drugs available, I'm also not a fan of people being against all drugs just because they're drugs, I like to know the reasons they're against them.

with DD1 they left the cord to pulsate before clamping, then I had the injection, with DD2 they had to clamp the cord sooner because I had PPH.

I think I would definitely go for it again - PPH is no joke, and stops the injection being optional really anyway.

[TheReturnoftheSmartArse]

Sorry, Robyn, what's PPH? [ignoramus emoticon]

[lovingthecoast]

post partum haemorrage

[Jojay]

Post partum haemorrhage

[azazello]

I had the injection with my first - it wasn't really an option but I think some of that was to do with the fact that the MW was looking after 3 women and she could just get me dealt with and go to someone else. It was all a bit rushed and overwhelming after a reasonably easy natural delivery.

With DS, I asked not to have it so spent 30 minutes sitting quietly on the side of the birthing pool feeding and cuddling him while DH cuddled both of us. The placenta then came out on its own. Much more relaxed and comfortable and a very peaceful welcome for DS.

I don't think I'm going to have any more DCs but wouldn't have the jab unless it was medically necessary to do so and I do think it is at least worth exploring the idea.

[TheReturnoftheSmartArse]

Ah. Thank you. Must be what I had then. All over the MIL's cream bathroom carpet. Who the hell puts CREAM carpet in their bathroom?!

[SurprisEs]

meditrina I had pethidine but I don't remember having the injection at all. Would I have been told I was being given it?

[mercibucket]

Doesn't it also affect the speed the cervix ctx with a risk of placenta getting stuck in womb or have I just imagined that?!?

[mercibucket]

Doesn't it also affect the speed the cervix ctx with a risk of placenta getting stuck in womb or have I just imagined that?!?

[NotJustKangaskhan]

Because just like every other medicine, it has risks and side effect - lethal ones in some cases. We should be looking into reasons to use drugs, not into reasons not to use them, but since you asked:

It's practically the same as the drug used to induce labour, but used to induce placenta expulsion: it's a large dose of synthetic oxytonin to tone the uterus (and in that prevent PPH). The problematic side effects for induction are also found in some that have the induction. However unlike induction which can be done little by little, this is dose that is estimated and done all in one go so not as controllable.

Personally, I experienced agonizing pain (and having just been in natural labour, saying the pain was 10 times worse is an underestimation of the pain), abdomen 'tender' to the touch (meaning I screamed whenever anyone touched me - and I'm not a screamer), plumetting blood pressure, rising heart rate, tachycardia, shock, maintained placenta and PPH caused by it, and loss of consciousness. It pretty much caused my uterus to clamp down and not let go and since the placenta was still attached at the time, I bled from the wound behind it that didn't get to close properly. I had to be put under to remove the placenta as my blood pressure was too low to risk anything else and transfusions. I woke up to be told I almost died and unable to hold my newborn properly as I had too many wires coming out of my hands (bloods, antibiotics, fluids).

So, PPH is not something to laugh about, but neither is the current most effective cure (sadly, research into the area is slim at the moment). Just as no one recommends getting induced without a medical reason as the risks outweigh the benefits, I don't see why this should be different - other than the NHS documentation on it right now pretty much portrays it as a magic stop PPH shot without anything from the side of those hurt from it.

[Earwigwam]

I have also heard the injection has two components and it might be possible to have one or the other seperately to reduce the risk of side effects. We need someone with some specialist knowledge.

[Tangle]

IIRC the injection will be either syntocinon (the same drug as is used during induction) in isolation or it will be a combination of synotcinon and ergometrine - often known as syntometrine. The ergometrine is the component that seems to get the blame for many of the "minor" side effects (such as nausea) and is also what encourages the cervix to close again, starting the clock ticking re. placental removal. As far as I know the ergometrine is included as the combination is more effective at stopping excess bleeding from the uterus.

Talking to MWs who have perhaps more than average experience of physiological 3rd stage, it seems that overall blood loss will tend to be similar regardless of whether the 3rd stage is managed or not - just that if the injection is given the immediate blood loss will be reduced but the lochia will then be heavier and last longer.

IMO whether or not to have a managed 3rd stage is a very personal decision - and is one that should be flexible depending on the way the birth has gone to that point and how the 3rd stage is progressing. A physiological 3rd stage is dependent on natural oxytocin being produced - and the calmer and more relaxed the birth has been the more oxytocin is likely to be produced (and can be increased by skin to skin with new baby, starting BF, peace and quiet, etc). The more medicalised the birth has needed to be the less likely a physiological 3rd stage is to be appropriate or safe.

Also IMO, the biggest risk in a physiological 3rd stage is having a MW who is unfamiliar with the practice and tries to make it fit into the paramaters and guidelines of a managed 3rd stage. I've heard of MWs applying significant cord traction (which should never be done with a physiological 3rd stage) and withholding the baby until the placenta is produced (not likely to bring about the desired result). If you are planning a physiological 3rd stage it is prudent to make sure that both you and your BP are very well briefed on how you expect things to progress, and possibly having it written up as well such that it can be handed over if the situation seems to require it.

Its worth remembering that (contrary to what some women seem to be told) you can have the injection at any point - immediately after the birth, after 5 minutes, after a fixed period of time if things aren't progressing, after an indefinite period of time if you're getting bored of waiting, not to mention if your medical condition seems to dictate it might be a good idea. Its not something that needs to be cast in stone before you even go into labour.

Previous PPH is something that should be considered - but if you're interested in a physiological 3rd stage I'd always suggest getting hold of the hospital notes from the previous labour to try and understand whether there's any underlying reason why the PPH occurred. For example, I had a PPH with DD1 - but it came from a vaginal tear rather than the uterus so no-one I've talked to has suggested that it is a reason to avoid a physiological 3rd stage in any future births. There are factors that can increase the risk of PPH (such as assisted delivery) - if a lot of those factors were present in a birth that resulted in a PPH, does that mean that the individual woman is prone to PPH or that the way the birth progressed and managed predisposed her to a PPH in that birth?

As to "why wouldn't you have it" - its actually quite scary how little research was done on it before its introduction in the 70's. But it became standard practice such that everyone seems afraid not to have it. I'd also re-frame the question and consider why, in the absence of clear medical need, why would you have it?