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3rd stage of labour .....managed or natural.............vit K what was your decision???????

(37 Posts)
inzidoodle Mon 24-Sep-07 13:27:52

sorry if this has been discussed before, I am 35 weeks and I cant decide on wether to have a natural 3rd stage or managed, what did you choose and why??? my first baby was stillborn and the third stage was managed, however I remember bleeding heavily and my blood pressure dropped very low I kept passing out (not sure if that was more to do with stress of losing baby) also vitamin K for lo, again what did you choose and why??? would be grateful for advice/opinions on this. Thanks XX

Loopymumsy Mon 24-Sep-07 13:34:58

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ladymac Mon 24-Sep-07 13:41:18

Inzi, I am sorry for your loss.

I had 3 natural 3rd stages and for the 4th I decided to have it managed because I was over 40 and had read that older mums have a greater risk of heavy bleeding.

I didn't really notice any difference.

My first 2 kids weren't given vit K (my choice, but so long ago I can't remember my exact reasons!) and the next 2 had it orally.

TheBlonde Mon 24-Sep-07 13:43:25

I had the jab for the placenta both times
First time I was knackered and happy to have it over with. TBH I reckon the MWs were jab happy and I would have had to strongly object to avoid it

With no2 I was fairly anaemic so they threatened me with jab & drip for the placenta. Got away with just the jab

VitK - both mine had it orally.

inzidoodle Mon 24-Sep-07 14:14:53

thank you lady mac smile

like the idea of waiting with the syntometrine then chosing to have it if things arent happening loopy, didnt know that was a choice tbh

is vit K orally better than injection???

alicet Mon 24-Sep-07 14:15:21

Hi Inzi!

I gave ds vit k orally and owuld plan to do the same with this lo. Can't remember my exact rationale on this now but had read about it all last time and was happy with my decision.

Ended up with emergency section last time and was put on a drip with syntocinon in it which I think is pretty standard in this situation as the risk of haemorrhage is greater. To be honest didn't really care at that stage. I had planned to have the injection though and if I end up with a vaginal delivery this time I will do the same. Again can't remember my reasoning but went through it all last time and baby plus todler brain means I can't do the same again!!!!

inzidoodle Mon 24-Sep-07 14:21:05

thank you alicet, I have read so much about these subjects I just feel confused on what is best to do!!!!! my dh wants me to have the injection as I did bleed heavily last time, but hate the thought of getting crap injected into me, I refused my anti D for the same reason (although I will have it after birth) it just seems hospitals chuck everything at you instead of leaving you to do things naturally.

Loopymumsy Mon 24-Sep-07 14:22:09

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lizziemun Mon 24-Sep-07 14:26:56

I had managed 3rd stage both times, for selfish reasons as i wanted to be able to have a shower and get cleaned upblush.

As for Vit K i did injection, as my sister has a blood cloting probelm.

ejt1764 Mon 24-Sep-07 14:40:32

inzi - I'm planning to do as loopsymumsy suggests - on my birth plan, it reads:

Third stage
• I wish to have a physiological third stage. Please do not inject me with Syntometrine unless there is an obvious bleeding problem.
• I would like for the cord to stop pulsating before it is cut.

however, as far as I understand it, it is only recommended that you have the injection as a matter of course if you have had drips (induction) and whatnot during the birth ...

VitK - ds had it, this lo will be having it too.

Nbg Mon 24-Sep-07 14:43:22

I have had managed 3rd stage for both my children and will again for my 3rd.

They both had VitK but orally. My thinking on it was that they have enough jabs in their first few weeks so let them off on this one grin

It does vary though depending on how you feed.

sweetkitty Mon 24-Sep-07 14:44:54

ejt - your birth plan looks exactly like mine

DD1 I had a managed third stage, disaster almost needed surgery

DD2 I had a homebirth natural third stage (MWs weren't used to this and were a bit nervous) cord wasn't cut until it stopped pulsing DD1 had her first feed still attached which was lovely. Placenta delivered about 20 minutes later no problems.

SlightlyMadSweden Mon 24-Sep-07 14:46:54

I had a physiological third stage with DD3 (DTDs were a manual removal of placenta so don't count).

Great wouldn't hesitate to do it again. Wait until placenta is delivered to cut cord. That is the way nature intended it. Nature intended baby to have that blood or the placenta wouldn't keep pumping it for 20-30mins. DD3 didn't have any evidence what so ever of jaundice and I think delayed cord cutting helped.
The only problem that I had was that her cord was too short so I couldn't hold her until cord had been cut, but I was on all 4s with her on a beanbag underme so she was close.

I was worried that I would have to have more contractions (i.e. more pain) to deliver placenta this way, but it was not painful at all. I just had the 'pushing pressure' no pain at all.


If there are problems for you or baby there is no reason they can't have the synometriene on standby and give as necessary.

inzidoodle Mon 24-Sep-07 14:52:32

oh good ideas loopy and ejt, thank you smile have used yours ejt in my birth plan and added discussion of syntometrine if not del placenta in 30 mins. feel better about this now!

OK so vitK what is the difference between orally and injection. Has anyone refused it?? or is it normal to have it??

crokky Mon 24-Sep-07 15:06:10

Inzi I'm sorry for your loss. Did they possibly give you any reason for the heavyness of your bleeding as I would say if they did, it may be relevant to your decisions re managed 3rd stage and vit K for baby?

When I had my LO (they knew 3 weeks beforehand), my liver had packed up. This meant that my blood was not clotting properly (and presented a risk to my baby's blood not clotting properly as well). Since Vit K is protecting baby against haemorrage it is worth having it injected if there is any reason to think baby may be more likely than the next baby to bleed. Re the safety of vit K, I believe it has been injected in the UK for years (certainly I had it when I was born, my mum had no choice in those days though!). My baby was also 3 weeks early so this made it more appropriate for the vit K to be injected.

For the 3rd stage, I thought that the sooner they delivered the placenta, the sooner they could get your uterus "closed up", they can give you a drug to close your uterus up. (I believe the advantage of doing this quickly is being less likely to bleed heavily). Again as I was at risk of bleeding, I had a managed 3rd stage together with the drug to get me closed up asap.

puffylovett Mon 24-Sep-07 15:15:37

i chose vit k orally because there was some studies done a few years back possibly linking vit k injection to an increase in childhood leukaemia - i don't think it was ever proved but i'm anti injections anyway really.

i feel that any vit or mineral is metabolised differently by the body when it is taken orally rather than injected, so chose that option.

at the time i'd been reading about the way the body deals with diseases or some such !!

inzidoodle Mon 24-Sep-07 15:21:34

thanks crokky, I never found out why I bled so heavily, it was maybe a 'normal' amount I just remember going for a shower and blood being everywhere then passing out. I know that my BP kept dipping as I had to keep lying down, cant remember midwives being very concerned about it though??

sounds like a lot of you chose vitK orally, think I might consider that over the injection.

barbamama Mon 24-Sep-07 16:56:39

So sorry to hear about your loss. I have had 2 ds's, gave them oral vit K both times (means 1 does they give after the birth, one the midwife does when they come and see you on day 7 at home and one you have to sort out on day 28 - GP or Hv or whatever. We decided on oral just because it is available and there was some concern about the injection being implicated in childhood leukaemias some years ago - though I think that has been largely ruled out now. We just felt giving it in a syringe was nicer for a newborn baby than a jab plus i was a bit sick of drugs and medical intervention the first time.

For the 3rd stage, I planned to have natural for the same reasons - but first birth went tits up so they gave me the injection. Second time I did have natural and felt it was much better - came out no problem after 30 mins. Also I recovered from the birth a lot faster and the blleding was less but don't know if this is becasue the second birth was less traumatic.

I would go as natural as possible if you can, then if any interventions are needed they don't stack up. Good luck.

inzidoodle Mon 24-Sep-07 17:01:42

thank you barbamama and everyone else I think I will go for oral vitK and natural 3rd stage unless problems or placenta taking too long, thank god for mumsnet!!!!

Littlefish Mon 24-Sep-07 17:05:49

I'm probably too late for this discussion Inzi!

In my birth plan I put that I would like a managed 3rd stage. However, when my lovely, lovely midwife read my birth plan, she suggested that we just wait and see. She said that if my labour went well, and I had had an intervention free delivery, then she would suggest a physiological 3rd stage.

She was absolutely right. I had a wonderful waterbirth, and then delivered the placenta naturally within 15 minutes.

DD had Vit K orally.

inzidoodle Mon 24-Sep-07 17:10:16

thanks littlefish, you just reinfoced my decision, feel so much better now, have been stressing on what the right thing to do is, it seems most of you have the same opinion which makes it much easier x

BetsyBoop Mon 24-Sep-07 18:12:25

I found this site a helpful reference

I've decided to try a natural 3rd stage this time, but happy to have the jab if I encounter problems

MrsFish Mon 24-Sep-07 20:56:41

Hi Inzi

At my last mw appt we discussed these two things. I have gone the same route as I did with ds1, a managed 3rd stage and VitK injection for lo. It meant the third stage was over and done with quicker, I barely bled afterwards either, well relatively speaking as I didn't really know what to expect. Also my mw said if you do the Vit K orally they have to have it about 3/4 times??, and you will have to administer it once you get home, whereas the injection is a one off, and blimey its the least of lo's problems after going through the labour

maxbear Mon 24-Sep-07 21:13:22

I had physiological third stages both times and mine were 25 mins and 10 mins respectively. I did bleed quite a bit second time round but not enough to cause any serious probs and I would do the same again. You will almost certainly be strongly advised to have a managed third stage if you had dangerously low bp and a heavy blood loss last time. Do you know how much blood you lost last time and did you need a blood transfusion?

barbamama Mon 24-Sep-07 21:39:44

With the oral vitamin K they have 3 doses:

Day 0: shortly after birth given by the midwife that delivered the baby.

Day 7: given by the community midwife that is coming to your house to check/weigh baby etc (or possibly you may be going to the clininc rather than having home visits in some areas)

Day 28: depends on health authority - for me done by the midwives at the hospital, last time (different area) the HV at the baby clinic. This is the only one you need to make an appt for.

Beware of midwives that try to dissuade you out of oral vit K or physiological 3rd stage - they have an agenda - neither are any extra hassle for you - just them! (they can't nip off straight away after the birthand have a cup of tea as have to stay until placenta delivered and oral vit K means finding a doctor to sign the prescription chart).

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