Third stage 'active management' - Does it increase the risk of retained Placenta?

[AmiWhatAndWhy]

My DS is now 2 1/2 and lots of things went wrong during his birth, it's only now I've actually taken time to read up about it and it has made me so angry.

It was a normal vaginal birth, with just G&A. In the hazy post birth moments I remember being jabbed and the midwife said, 'it's just to help the placenta come out'. She then tugged on the cord, bits came out and I ended up needing an epidural in theatre for manual removal of the rest of the placenta.

I was never told previously, or even then, about this injection or how it works, or asked if I wanted it. I am convinced that it did more harm than good.

It's only come to my mind lately as my friend had exactly the same thing. With her it was a home birth, she was jabbed and ended up going to hospital.

Can anyone direct me to good sytatistics, or let me know why I wasn't informed about this possible intervention before giving birth?

[Tommy]

can't remember what the injection is called but, with DS3, I had a homebirth and didn't have it - 5 days later, I was rushed to hospital with an infection in the retained placenta

The consultant said when she discharged me "If you have another baby, by all means have another homebirth, but make sure you have the injection"

which would disprove your theory I guess!

[jellyforbrains]

I had this injection both times with no problem. Though like you, with my 1st DC I hadn't even heard of it until I was about to start pushing and midwife asked if I wanted it after baby came out.

The second time I was planning on pushing the plancenta out without, but by the time I had my baby I didn't want to push any more and had the jab! Also, had heard that retained placenta could happen and as 2nd birth was at home just wanted it out in one piece and had heard that this was more likely with the injection.

Sounds like in your case it happened anyway . However, from what I have read this is less likely if you have the injection. Don't know any facts and figures though. I am sure that some more knowledgeable people on here will know more.

[poppy34]

dunno about detailed research but when did my antenatal classes think the risk of not being jabbed and letting it happen naturally was higher risk of bleeding/retention than not. But then it was fairly equal both ways as I remember on what risks were of complication (ie jab or not).

and having retained bits removed is no bloody joke so sympathy there.

[ILikeToMoveItMoveIt]

The injection is called syntometrine (sp?!)

[whinegums]

I've been exploring this too. From what I can see - it appears there may be more bleeding at delivery, but lochia eases up more quickly. Also, some hospitals give syntometrine, some syntocinon. Syntometrine encourages the uterus to contract more quickly, increasing the risk of retention.

FWIW, I have it in my birth plan that I don't want to be offered the injection until after I've given birth and the cord has stopped pulsating, and I'll make a decision then. I suppose at that point I may just want it all over, but I'd rather decide at the time than be jabbed as I deliver (which I believe also means the baby has to be separated immediately; I want to wait for a little while before the cord is cut).

[Wade]

I didn't have the injection and had no problems delivering the placenta or afterwards. My understanding is that it reduces the risk of heamorrhage and speeds up delivery of the placenta. If I had had any intervention eg forceps etc which make haemorrhage more likely, I would have had the injection but saw no need as I was fortunate enough to have a straightforward birth. Some of the possible side effects of the injection are listed here.

www.netdoctor.co.uk/medicines/100002520.html

[beanbearer]

First time was jabbed as soon as DD born, second time insisted they wait to cut cord till no longer pulsing and was going to try natural 3rd stage but after about 20 minutes decided to have injection to speed things up and let DD come to meet brother before bedtime. BIG difference in amount of postnatal bleeding - 2nd time more like a moderate to light period after 24 hours whereas 1st time was copious amounts for over a week.

[bb99]

The injection was explained to me - it's supposed to make the blood vessels in your uterus contract and stop the blood flow to the placenta, making it come away more easily and preventing post partum bleeding, or reducing it. Second time I had it we waited until chord blood had been collected, then had jab and out popped placenta.

Don't know the sats, but I've had it twice and not had any problems with it - only time I had retained products eg placenta bits left behind, was when I didn't have the jab with a late mc. SIL had jab and retained products, but not every placenta comes away in one bit IYSWIM.

Good Luck and the choice IS yours - put it in your birth plan eg. BIG letters saying - remember to ASK me!!

[Pruners]

Message withdrawn

[barking]

Hi AmiWhatAndWhy
I had a retained placenta and was terrified of having children again.
I did lots of research via the Lancet and found the Hinchingbrooke trial. It is regarded as the definitive report with regards managed and unmanaged third stage. I think it took part in Bristol, 1998 and involved 1500 women I have tried googling it to paste it here, but can only find references and part of the study on the web.
I managed to get the info by registering with the Lancet, then accessing the full publication from there.
lancet

[MGMidget]

I did a lot of research on the internet on this as something similar happened to me. I had it in my birthplan that I wanted to deliver the placenta naturally unless I started bleeding heavily. However, they clamped the cord as soon as my little one came out and stuck the drip in within a couple of minutes despite my protests. Umbillical cord snapped when house officer tugging on it so he plunged his hand into me without warning (and without epidural) and started fishing out the placenta (excrutiating painful). I can't remember where I saw the stats now but if you search google with key words such as 'retained placenta + snapped umbillical cord' you can get links to various articles and websites. I did read that there was a higher risk of retained placenta when the drip is used and umbillical cord pulled - makes sense really that it might snap as a result doesn't it? I also read that its often a misconception that having the drip reduces bleeding as it often just delays it - e.g. I bled for 10 weeks after the birth. Reasons for doing managed delivery could be down to hospital 'protocol' (possibly governed by their insurance company's requirements), or the preference of whoever is doing it or perhaps even their own desire to speed things up when there are people in the waiting room!

www.ingentaconnect.com seems to have lots of medical articles on it - you may have to pay to view them.

There's also a radical midwives website you could search for where I seem to remember seeing lots of views about managed versus natural delivery of the placenta (possibly stats quoted).

[lumpasmelly]

I had a retained placenta after DS2, and ended up in Theatre with them fishing it out in bits. I also remember having the injection and it making me vomit. Not sure if there is a link though, as the doctor who was fishing it out, mentioned that it was "stuck" firmly and mentioned something about "placenta accreta" which I've subsequently found out can be quite serious as the placenta grows into the uterus too deeply and then doesn't detach which can lead to a massive heamorrage. Apparently placenta accreta is rare, but on the rise due to people having c-sections, or d&cs - something to do with the scar tissue. I only managed to find out a bit more as it turns out they had managed to leave a bit behind so i needed another d&c to get that bit out! Nightmare!