'Managed' or 'spontaneous' delivery of placenta

[verytiredmummy1]

I'm aiming for a VBAC and I haven't got my consultant for a few weeks but have been asked to fill in my birth plan.
Does anyone know which mode of delivery of the placenta is better for a vbac if any? X

[Dixiechick17]

I chose for managed delivery. By that point I just wanted to enjoy my DD and get that part over with, placenta delivered fairly quickly after I had the injection

[sycamore54321]

I don't know specifically for VBAC but I'm not aware of any benefits of awaiting delivery of the placenta, only greater risks of PPH, uterine exhaustion etc. But you are right, this conversation would be best had with your doctor.

[verytiredmummy1]

I've read that delaying it can help baby as they get more oxygen rich blood this way. I will ask my consultant but as appointment is a few weeks away I want to find out a bit first but there just doesn't seem to be that much info out there :( xx

[WiMoChi]

Do you mean delayed cord clamping? Most hospital do this as standard now I believe?

[StandoutMop]

I had managed with dc1, mostly so mw could finish with me and go to someone else (short staffed). The drug made me throw up but otherwise all fine.

Natural for next two, no real difference. Didn't take longer as far as I recall. But would've had managed again if needed.

[alltouchedout]

I think I had managed with ds1, can't really remember. Natural with the next two. Took ages, about an hour I think- was arguing with the midwives that I was fine to wait and still didn't want the injection when the pains started- til I got contractions with it with ds 2 but pushing it out was quick and easy. Didn't take so long with ds3 and again it was easy.

[verytiredmummy1]

Sorry I don't think I made it clear, I mean natural delivery of placenta rather than the injection to speed it up xx

[BurnTheBlackSuit]

With mine, not having the placenta injection for one and having it for the other, I found that I bled more but for less days when I didn't have the injection, whilst with the injection, I bled slowly but for much, much longer.

No idea if that was just me or not. But it makes sense to me that it would work like that.

[BurnTheBlackSuit]

I mean- it makes sense because the injection stops major blood loss on placenta delivery, which is a risk, but therefore must slow down blood loss.

[SweetPeaPods]

I had managed for both, I just wanted it over with so I could enjoy baby with peace from the mw

[alltouchedout]

Oh, I thought the difference between natural and managed was no injection and waiting for it to just happen, or injection to induce it. What is the actual difference? I feel sort of thick not knowing after 3 dcs!

[sycamore54321]

burn the two types of bleeding are different - once the placenta starts to come away, the major artery that has been bringing your blood to becomes an open 'pipe' where it ends and can only be sealed off by your uterus shrinking down in size and thereby sealing it shut. If the uterus does not do this quickly enough, your blood continues to flow out of this artery into your womb and can cause life-threatening blood loss very quickly indeed (in the same way as any other artery would allow you to bleed out if it was severed or opened in any way). Normally but not always, your uterus continues to contract and thereby cuts off the outpouring of blood as it shrinks down and all is well in most cases. The injection is a way of assisting with or guaranteeing this process by adding an extra dose of the hormones that cause contractions. I am not aware of any downside to it myself - this all happens after the baby is born.

The general bleeding in the days or weeks after birth is called lochia and is essentially the equivalent of a period - it is not fresh blood from your blood vessels but rather the shedding of the lining of your womb, which has built up throughout the pregnancy.

[verytiredmummy1]

Anyone know which way is best for vbac? Xx

[wigelspigels]

Not sure what is the best way for VBAC, but I had natural with both placentas no issues. The 1st one took about 30mins and the 2nd time 6 weeks ago today, that went far too quick it came out very fast not even 10 mins and it shot out.

[Room101isWhereIUsedToLive]

With my vbac I wanted to have a natural placental delivery but when it came to it I had to have a managed one as the blood loss I was experiencing was on the high side. It was over in moments and I'd quite happily have the managed delivery again.

[MrSlant]

I had mine removed by hand, once in theatre with a spinal and once in the room I delivered in with only half my epidural working. Feeling someone's fingers inside your uterus as they double check for clots after it has come away is MOST unusual . It was massive apparently, something I am unusually proud of (the placenta btw, not my uterus, although I guess that wasn't the smallest it has been).

I think the argument for the injection is it makes sure it comes away before the space for it to come out of has started to shrink too much. I think it's definitely a question for the professionals. Unless you are delaying clamping the cord for a long time it shouldn't make any difference to your baby.

[Newlywed56]

Lol at MrSlant... I would've gave my right arm for even half an epidural. I had a retained placenta, doctor removed it with his hand and I had gas & air only..... Is it any wonder the thought of giving birth again l. terrifies me .. Sorry getting off topic is go for the managed, there's a reason it's offered, I had a Pph and lost 2 litres with injection and had to have 2 transfusions. I wouldn't like to know how much I would have lost without it

[RadicalPessimist]

I've had both. The injection to deliver the placenta quickly made me vomit so I opted for natural management the next time. It was straightforward for me. I had an urge to push a couple of minutes after DD was born and the placenta plopped out with no problems. My midwives were happy for me to do this but you need to discuss the issue with someone who knows your medical history.

[adagio]

Not vbac, but I chose natural with both of mine as my research indicated a risk that the injection could make your cervix close too fast increasing risk if retained bits of placenta, whereas natural is more of a chain reaction or shear off/push out/close cervix. Both of mine turned up easily within half an hour, I planned that if they didn't turn up within the hour I would then consider moving to managed. Google managed third stage v natural third stage for some good articles and make your own mind up.
Good luck!

[frikadela01]

I wanted to deliver it naturally however I was so delirious and out of it after the birth that I found myself saying yes to the injection. the feeling of pushing out the placenta was bizarre.

[TaurielTest]

I had physiological third stage on my birth plan both times - for the reasons that adagio mentions, greater risk of retained placenta, plus preference for drug-free if possible (synto can give you a headache).
In both births, I ended up consenting to the injection - first time round nothing had happened after 45 mins and mw was concerned about blood loss.

This www.nct.org.uk/birth/third-stage-labour suggests that if you do have the injection to 'manage' the third stage, you can't request delayed cord clamping as the mw will want to prevent the synto reaching your baby's bloodstream.

[IamChipmunk]

puddock not read the link but I had delayed cord clamping then a manged 3rd stage with injection, no problem.

It's on my birth plan second time round too. Midwife has read it recently and not commented on it being an issue...

My birth plan is also an nct template!

[CatsCantFlyFast]

Another one who had delayed cord clamping (still in the pool) then got out and had the injection for placenta delivery so it can be done

[randomsabreuse]

Didn't have an opinion and DD was ventouse and they were concerned she was slightly distressed so cord was clamped once out. Realistically I wanted everything over at that point including the stitches so I assume that had something to do with it. My birth plan was play it by ear and yes to vitamin K though...

[frikadela01]

I too had delayed cord clamping then the injection. In fact delayed cord clamping is standard practice in my trust unless there is a medical reason not to.