Assisted delivery of placenta

[Koumak]

Any thoughts on being given an injection to contract my womb before the delivery
of the placenta.

To have or not to have the injection?

What did you do?

[Ladyem]

I've had the injection for both my labours and was fine both times. Placenta delivered within a few minutes with just a little tug from the MW, which for me was great as I just wanted to be cleaned up, cuddle my little one and have a bath!! No way I could have waited around for another 30 mins or so for it to come naturally as you still get contractions happening (albeit not as strong as ones to get the baby out!) until it comes out. I'd had enough by then!!

Good luck whatever you decide to do!!

[norktasticninja]

With DD I had the injection and with DS I didn't. TBH the placenta arrived after about the same length of time both times (a few minutes) and the blood loss was very similar too. I didn't have contractions between the birth of the DC and the birth of the placenta either time, although I did feel a slight urge to push as it came out both times.

I'd say wait and see how you feel at the time. If the placenta is taking longer to come away than you (or the HCPs) are happy with you can always have it then.

[norktasticninja]

Oh, and I cuddled with DS (no injection) whilst I waited for the placenta. DD was whisked away at birth so that was another story...

[Deeeja]

I didn't have it, and the delivery of the placenta was barely noticeable. Breastfeeding straight after the birth helps to deliver the placenta quicker.

[MrsMerryHenry]

Good tip about bfing, deeeja, I didn't know that. Will remember this time around...

[MrsMerryHenry]

Actually, why do they offer an injection? The only justification I can come up with is that it speeds things up and gets you off their hands more quickly. Surely there must be a better reason than that?

[Ladyem]

I was offered it the first time as I was bleeding heavily and if they'd have waited for the placenta to come out naturally I'd have lost a lot more blood.

[thisisyesterday]

i had it the first 2 times
didn't have it the third time because by the time the midwives arrived i was about to deliver it naturally

[TheMightyToosh]

It is a safety precaution -the injection is to avoid problems with the placenta being delivered too slowly or partially or not at all. It can be very dangerous to you if it isn't delivered swiftly and fully.

Why would you not want to have it? It is a tiny injection, has no impact on you, and you don't even notice it as you're too busy with your new baby! Better to be safe than sorry, IMO.

[reikizen]

As long as labour has progressed normally there is no reason not to opt for a 'physiological third stage'. Studies have shown that although it may take longer and the bleeding may be slightly more this may be balance out by less bleeding in the following weeks. As a previous poster suggested, breastfeeding releases the same hormones needed to contract the womb so well worth doing. Also making sure bladder is empty. However, if you have had any intervention such as induction or epidural, or a very long labour it would be wise to opt for an 'active third stage' as you would be trying to pre-empt any problems with the uterus contracting and expelling the placenta. If you started with a physiological and excessive bleeding started to happen, they would then use an oxytocic injection as a first line. Be aware though that different midwives have different 'comfort levels' about physiological third stages due to experience. Hope that helps.

[norktasticninja]

Over here (the Netherlands) it's given routinely in hospital and not given routinely at home. Not having it in hospital is just as difficult as getting it without reason at home.

I'm not sure exactly why it's deemed necessary in normal circumstances (no history of PPH etc).

[norktasticninja]

x reikizen

[memorylapse]

I had it with all 4 of mine..I barely remember having the jab tbh as I think the midwife pounced with the needle while I was engrossed with my new baby

[reikizen]

Reasons not to have it may include the fact that it makes many women suffer nausea and vomiting, and that it is an unnecessary intervention to a normal labour. There are also reported problems with severe headaches and blood pressure. It does not prevent post partum haemhorrage although it is a useful tool if something does go wrong.

[CarmenSanDiego]

Actually, TheMightyToosh, there is a risk with it that it can cause the uterus to contract too quickly, causing retained placenta. On top of other side effects.

I opted for a physiological birth - you can always 'wait and see' if there is too much bleeding or the placenta isn't being expelled properly. As a previous poster says, breastfeeding encourages proper and fast release of the placenta.

[franke]

I didn't have it for either of my labours and didn't have to wait long. I don't remember having any contractions to get it out either. Michel Odent wrote an article about the time immediately following a normal birth. He suggests even just holding and gazing at your baby undisturbed will help release the natural hormones/chemicals required to get the placenta out. Certainly worked for me.

[TheMightyToosh]

Of course there are risks with any intervention, but the benefits (or the risks associated with not having it) obviously outweight the risks of having it, otherwise it would not be routinely given, or even offered, or indeed approved for use.

[CarmenSanDiego]

My very experienced home birth midwife had herbs to treat a pph. She also carried syntocinon but said the herbs had always worked for her!

[CarmenSanDiego]

Not strictly true, Toosh. There are plenty of procedures where the risks outweigh the benefits but they happen for other reasons such as tradition or convenience.

[Kingsroadie]

This was dicussed in our most recent antenatal class so it has been on my mind too. Our "teacher" said that one of the possible disadvantages of having the injection is that the placenta doesn't detatch from the wall as swiftly as anticipated and meanwhile the cervix is closing and sometimes it's a race against time to get the placenta out before it closes (if it doesn't make it they then take you into theatre and manually evacuate it I think). The other thing she mentioned was the slight risk of retained placenta (although I would imagine that could happen without the injection too?).

I am now not sure what to do - I suppose if I have an all natural birth then just continuing down that route and delivering the placenta naturally might seem to be the most logical course (although having it over and done quickly does sound quite appealing, plus it helps the blood vessels contract I think). But if I need intervention/epidural etc then I will have it as I think they advise that. I haveheard though that they do give the injection pretty sharpish as a matter of course so you have to be quite on the ball if you don't want it...Tough decision!

[reikizen]

Oh yes, for example in the 70s it was routine to give women an enema, shave them and give them an episiotomy into the bargain. All routine interventions which have now been proven to be of no benefit. Many obstetric (and I'm sure medical in general) interventions occur for reasons other than those we assume! But of course there is no way most people would know this as we assume they are done for our benefit.

[CarmenSanDiego]

Yes, syntocinon reduces the risk of pph. That's the benefit and it's probably advisable for people with bleeding problems or a history of haemmorhage.

But...

There's also research showing that active third stage management clamps the cord too early. This has a negative effect on the baby's iron stores and blood volume.

There aren't really many clear studies comparing the outcomes of active v. physiological third stage and it's not quite as clear cut as some obstetricians might suggest. Snapped cord and retained placenta are more common than one might think.

[TheMightyToosh]

Carmen - all medical procedures have to undergo strict testing and regular reviews before they are approved for use and included in practice guidelines, and if the risks outweighed the benefits, they would not be approved, let alone paid for by the NHS/NICE.

These bodies do not approve things based on tradition or convenience.

[rolledhedgehog]

I had the injection with #1 after an epidural and long labour but the MW did make a point of asking me properly for consent.

With #2 it was a completely natural birth with no pain relief (by accident!) and the MW suggested a physiological third stage.

#3 was actaully induced by pessary and was a very quick birth. I am pretty sure that the MW did not even mention the injection so another physiological third stage.

I have to say that I was so busy cooing over the baby with #2 and #3 that I hardly noticed how long the thrid stage took, barely noticed it was happening and I bled a good deal less with the physiological third stages.

[CarmenSanDiego]

Kingsroadie, if you want a natural birth, you can tell them beforehand. They'll have the syntocinon standing by so if there's any sign of excess bleeding, they can whack it in.

To be honest, you won't be too worried about 'getting it over with' when it happens - you'll be busy with your baby and the placenta is very much an afterthought - with both my natural births, it appeared very quickly as I was breastfeeding.