VBAC research - third stage

[MrsHappy]

Is there any official guidance on whether drugs should be used to speed up the third stage in a VBAC?

I have looked on the NICE website with no joy.

Thanks

[bling1]

The amount of drugs they use, ie if you need to be induced, will increase the risk of the scar tearing. Best to speak to your consultant, but make sure they give you all the stats, and all the info both good and bad if you're still looking to make a decision on vbac or cs.
It's likely if you need to be induced, they'll try and break waters first, before going onto the prostaglandins, and may not give as much as to a mum who wasn't vbac. In terms of epidurals my consultant didn't mention there was any problem with this, and having seen my hospital protocol on vbac, it doesn't mention any pain relief is an issue.
Not sure if this helps!

[MrsHappy]

Thanks, but they're not proposing to induce me. They've just recommended drugs to manage the third stage (i.e delivery of the placenta) on the basis that I am apparently more likely to bleed than someone who has not had a CS, but I can't really follow the logic...

[l39]

I had a cannula in during my VBAC on Saturday. Once the baby was born I asked if it could be removed, but they wanted to leave it longer in case of excessive bleeding - they'd never mentioned that before, but it seems to agree with what they're telling you. I agreed to the third-stage injection and bled no more than usual - cannula finally came out without being used (they messed up the first attempt to site one so both my arms hurt at first, since they made holes in both.)

[l39]

Um, I left that rather unclear - I know you're asking about drugs not cannulas, but the thinking seems to be the same - that a successful VBaC has a higher risk of serious bleeding in third stage than an ordinary birth.

[MrsHappy]

Hm, I'm just confused because the injection doesn't seem to make much sense. Surely the more sensible way to go with the placenta is to wait and see what happens? Anyway, if my uterus can push out a baby why do they assume it will have difficulty with the placenta? It's all odd... And does the jab increase risk of rupture? It can't be all that different from induction drugs which do increase risks...
I can kind of see the point of the canula - which has no downside that I can see other than possible mild discomfort - but I am concerned there might be downsides of this jab.

Arg! confused!

[hobnob57]

I've read somewhere recently that the third stage drugs tend to reduce bleeding in all pregnancies compared with than natural expelling of the uterus.

Still not sure about VBAC risks on top of that though. Perhaps if there is a small scar tear then it might prevent excess bleeding from it?

[moaningminniewhingesagain]

When I looked into this I couldn't see any stats about the third stage being different for a VBAC.

I opted to plan for a physiological /natural 3rd stage but to have the injection if nothing happened after an hour or so. Or have the injection if I had a particular difficult labour, the same reasons to have it as with a non VBAC labour really.

[MrsHappy]

Thanks - that confirms what a friendly midwife told me yesterday - that she's not aware of additional scar-rupture related risks but equally she's not aware of significant benefits.

I had planned on waiting to see what happened and if things didn't look right (or if I was knackered) to have the jab.

[CarmenSanDiego]

I've not read anything about there being any difference between a VBAC and non-VBAC for third stage. Personally, I had two VBACs and a physiological/natural third stage for both.

[hobnob57]

mrs H found this today - something about the placenta embedding in the scar and causing excessive bleeding - would the drugs reduce the bleeding in this case?

[MrsHappy]

I don't know, but the placenta is nowhere near my scar, so not a concern. Thanks, though, Hobnob.

[MrsFlyingKebab]

I had a successful VBAC on Saturday and plumped for the injection just to get things over with. 3rd stage was 15 minutes. i had to work with the midwives to get round all the 'hospital policy' to get the birth i wanted so they were pretty clued up on risks and stuff. No one mentioned an increased risk of bleeding, in fact I thought the reverse was true and I haven't noticed any difference in my loss between this birth and my CS. I also had a canula which was a pain, but a compromise I could live with. I made them take it out as soon as they finished tidying up, which they did no problem.
I can remember having the quandary about having the jab, and I'm happy with my decision to have it. Hope that helps

[MrsHappy]

Thanks MrsFK. I am coming round on the canula point too (seems to have no real downside other than being annoying) but the jab appears to have more negatives.
I had always thought I would play it by ear, and that includes having it if I was tired and just wanted everything to be over and done with. But it is something the hospital has suggested so I guess I need to give it some more thought now. I doubt though that I am going to get comfortable with the idea of going through a drug-free labour and then having drugs to deliver the placenta without actually needing them.

[MrsHappy]

Oh, and congratulations on your VBAC!
(Sorry, am horribly self-absorbed right now )