Managed or natural third stage?

[Kingsroadie]

Hi - just need a bit of help discussing the options. I am almost 38 weeks and had thought that if I manage to deliver without an epidural I would try a natural third stage as I just figured the body knows what to do naturally surely? And if I start to bleed a lot then they can just give me the injection? But I am slightly worried about retained placenta etc as a result. Don't fancy a manual removal in theatre!

However, am now staring to think that maybe the injection is a good idea as it it now routinely given to everyone and so the benefits must FAR outweigh the risks? Obviously it is a lot quicker than a natural third stage, which isn't really an issue for me but do the midwives prefer it if everything is done and dusted quickly? Also on my maternity notes in the birth plan bit there are questions for you to think about. The phraselogy re syntometrine injection is slightly scaremongerish: "would you like an injection to reduce the risk of heavy bleeding immediately after the birth" which seems a little weighted towards a managed third stage.

Anyone have any pearls of wisdom? I am sure I won't actually care at the time but at the moment I can't mae a decision about what to eat for lunch, let alone this! baby brain...

Thanks!

[tassisssss]

I'd talk it through with the midwives. I've had both managed (twice) and "natural" for my middle child. For me the so-called natural was one of the worst bits (ok after the pain!) of my 3 lovely active labours. For me the midwives got twitchy about the placenta not delivering and they catheterised my (albeit v briefly) to empty the bladder in order to get the placenta out. Not particualarly nice though all over very quickly and I was well dosed up on G&A so can't even really remember it! But equally can't remember the end stages of the 1st and 3rd labours! And while there was a lot less bleeding than the first time I think this was more to do with not having stitches and an infection as the third time there was less bleeding too...

(not v helpful I know!)

[Kingsroadie]

Thanks! Sadly my midwife was less than helpful at my 36 week appt. I mnetioned the birth plan and she said there was no point discussing it and I should discuss it with the midwives when I was in labour... I then mentioned I couldn't decide re third stage and all she said was "it's up to you - I can't tell you what to do and suggest you read up about it online" (which I said I had already done obv). She then said if the midwife has to wait 30/40/50 mins for the placenta to come out and you are bleeding it is worrying for THEM. So basically she was about as helpful as a chocolate teapot. But I am kind of leaning towards the injection as it sounds as though you bleed less...

[flybynight]

I've delivered all three of my current children without an epidural, or indeed any pain relief, but I've never contemplated a natural third stage. I reckon the main show is over, lets just get on with it, then we can all get acquainted!

BUT that's not my main point here. My main point is: what a crap midwife! That is utterly shocking. No-one should ever be palmed off like that by a medical preofessional. You are her job, you pay her wages. How dare she brush you off like an inconvenience. If you don't find out at 36 weeks, when can you?

Bah. Rant over.

[chocolaterabbit]

I had a natural third stage with DS 4 weeks ago and it was marvellous . It proceeded on the basis that i would have the injection it the placewnta wasn't out within an hour but I perched on the side of the birthing pool being cuddled by DH and feeding DS and it was incredibly peaceful and relaxing. MW used the time to write up her notes after my very quick labour! I think although there was more bleeding before the placenta was delivered, there has been less since and no retained both of which I had with DD.

Would strongly recommend. MWs often don't like it appartently because it takes more time after the good bit of the baby beingborn (acc to a mw friend)

[Kingsroadie]

tee hee flybynight thanks for ranting - I felt much the same but couldn't be bothered to argue with her as she was like this before (she told me at my 10 week booking appt that if I "got sunburnt" I would "have miscarriage", same for sickness and diarrohea - which I had at 5 1/ weeks - norovirus and ... low and behold I did not "have miscarriage". She isn't English - eastern european and I know they are often more abrupt sounding when they speak english (I lived in eastern europe for 3 years when I was small) but still!

Yes chocolaterabbit I had wondered about the speed element and the pressure to get the room ready for the next person (esp in central London) - obv don't want to offend any MWs on here !

Am impatient by nature and part of me would like it all over and done once the baby is born as quickly as possible (esp if need stitches - gaah!) but part of me would like to just let nature take it's course. I realise this could all be academic if I have an epidural or intervetion...

[BertieBotts]

I always thought the risk of retained placenta was higher with a managed third stage, because it shortens the window in which the placenta must be delivered before the cervix closes. I may be wrong though.

Have you thought about the cord cutting for the baby? I decided to have a natural third stage mainly because I wanted to wait until the cord had finished pulsating before it was cut. With a managed third stage they generally cut the cord straight away.

[BertieBotts]

Also if there is more bleeding immediately after the birth (not talking haemorrhage levels here obviously) then presumably the lochia would be shorter which has to be a good thing.

[biggernow]

Hi- I had lots of bleeding immediately after DS1 shot into the world- so they gave me injection as were worried (i had wanted to do it naturally) but it was from tear, not placenta.
However, plus side of their major panic faced intervention (that was a nice moment...) meant third stage was over in less than 5 minutes and while they were stitching up my fanjo (sorry for tmi!!), I was able to enjoy my baby and relax in knowledge it was over, I was safe and so was he.

Due DC2 this week and will be having the injection again this time. For me, one less thing to worry about is a good thing. DS was a healthy little man and breastfed for 14 months etc so in my HUMBLE opinion- no perma damage from the injection.

Must also point out delivery of placenta actually felt quite nice- very slippery...!!!!

But it is a personal choice.

HTH a bit and good luck to you!

[BertieBotts]

Oh yes delivering the placenta feels lovely after the huge head!! I liked with my decision to not cut the cord straight away that it meant nobody could take DS very far away from me until that had been done, we had a nice cuddle, then the cord stopped pulsing so they handed him to DP to hold, my mum cut the cord (DP refused) and I knelt up and delivered the placenta with one push. They dressed DS and I cuddled him while they stitched me up.

[CatIsSleepy]

I had s managed 3rd stage with dd1 and ended up with retained placenta so wanted to try natural 3rd stage with dd2.

dd2 was a home birth and the midwives were quite keen to give me the injection but i was quite stubborn about it and we agreed a compromise that if i hadn't delivered the placenta within 30-45 minutes then I would have the injection. In the event it took about 20 minutes-I was cuddling and feeding dd2 the whole time (skin-skin contact and suckling helps the third stage) and it was not particularly painful-I didn't really notice tbh. It was a nice way to end the whole birth process actually!

[Lionstar]

I was adamant on a natural 3rd stage for my homebirth with DC2 (arrived 7 weeks ago), particularly as I didn't want the cord cut until the blood had stopped flowing. There was more bleeding after baby arrived, but the placenta arrived within 20 minutes after putting baby to breast and a bit more pushing (but no contractions). Midwives were getting a bit angsty though, tugging on the cord etc. I was very pleased to find the lochia only lasted a week.

With DC2 I had no choice over the injection because I was induced. It seemed to take ages for the placenta to come, the midwives got very panicky and I swear they yanked it out manually - it was as bad as the labour itself. Then I faced 6 (!) weeks of lochia.

[biggernow]

true re. lochia- i had 8 weeks first time round.. good point.

[Kingsroadie]

BertieBotts - I think my orginal post wasn't very clear - I meant I am worried about the retained placenta risk as a result of the injection, which I believe is one of the probems associated with it, as you say.

So if have a natural third stage then lochia is likely to be shorter (presumably as you have bled more prior to placenta being delivered?). I would prefer shorter lochia if possible - for purely selfish reasons . I was quite keen on the cord being allowed to stop pulsing so the baby would get all its blood. Something in my head is just saying that our bodies are meant to know what to do and the babies should get more blood after delivery etc so perhaps I will try for a natural third stage (assuming no intervention etc) as they can always give me the injection if placenta doesn't emerge after say 45 mins...I assume!

Thanks everyone so far - really helpful.

[rubyslippers]

i had a natural third stage this time - as i had more contractions the midwife pulled and out it came

took around 15 - 20 mins (i had to get out of the birthing pool)and no problems whatsoever

lochia lasted 4 weeks or so

[beautifulgirls]

I had managed 3rd stage with #1 and #2, and natural with #3. I had no problems with the natural delivery, placenta came out about 15-20mins after baby was born. I had DD in the birthing pool and waited for cord to stop pulsing before cutting it then got out to deliver placenta. Midwife was totally chilled out about it all and despite the water being quite bloody it didn't seem to be a worry - was a really nice atmosphere the whole way through
With #1 and #2 was flat on my back, epidurals and nothing nice about anthing that happened overall. I will say with #2 I had wicked afterpains, but after #3 they were not as bad though uncomfortable. Whether that has anything to do with the way the 3rd stage happened I don't know??

[julietbat]

I had a natural 3rd stage with ds two weeks ago. I was pretty insistent about it (as long as it was safe for me to do so) because I really wanted the cord to be able to keep on pulsating. Also, with dd two years ago I'd had to have a managed 3rd stage because of all the interventions I'd had and the injection made me soooooo sick. Ds's birth was so wonderful in comparison I really didn't want it to end with me throwing up violently into a cardboard bowler hat again.

[lucasmama08]

I had a natural 3rd stage with my first birth and, all being well, plan to do the same with my second.

It was in hospital and it was all pretty laid back, although the MW did explain the risks when she read my birth plan and once gain, very briefly, after DS was born. I can't remember any pain or contractions with it (although I believe you feel them more with subsequent births?) and it seemed to pop out almost straight away which took me by surprise as I expected a bit of a wait.

I did say I'd be happy to have the injection should the placenta not put in a timely appearance or should anything else out of the ordinary happen so that might have been why my MW was ok about it.

I don't have anything to compare the lochia to, but my experience was that I seemed to bleed quite heavily whilst I was still in the delivery room (where I remained after the birth) but that it had slowed to a sort of mega-heavy period by the time we got home 8 hours later. It took about 2 - 3 days to slow to what I'd consider a normal period-type bleed then gradually trailed off over the following weeks.

[swissmiss]

I had the injection with DC1, it never came up for discussion not to, no problems! Had natural 3rd stage with DC2, actually at m/w suggestion, no problems either. Had natural 3rd stage with DC3 but to no avail, followed by injection after 60mins waiting, then theatre for manual removal. However I did have a morbidly adherent placenta so honestly neither method was going to get it out without physical intervention. Thinking about it I knew something wasn't quite right as once DC arrived I didn't have a single further contraction.

Can't really comment on lochia as it was awful, 12+ wks, after DC1 (injection) due to failed tear repair, ok-ish, 6 wks, after DC2 (natural) and very little, 2.5wks, after DC3 (theatre removal) as the dr had taken most of it out sorry if TMI.

Previewing that has made me realise that what I've written probably won't help you make your mind up at all!

[spiderlight]

I'd definitely have a naturla third stage next time. I had the injection and had a retained placenta, at which point the midwives fiddled so much that they snapped the cord inside me. They then panicked, insisted on catheterising me even though I knew damn well my bladder was empty, and eventually called out the paramedics, announcing that after my perfect drug-free home birth I would now be having surgery to remove the placenta . Fortunately, fuelled by pure annoyance, I managed to push the flaming thing out in the time it took the paramedics to arrive and they were duly sent away again, but it was all horribly unnecessary and ruined what should have been a wonderful first hour with my son. In retrospect all I needed was a few minutes' rest and quiet with DS and none of it need have happened. If there's a next time I'm going to tell them where to shove their injection and have a completely natural third stage.

[redtent]

I had a natural 3rd stage with ds 3 and whilst it was the most uncomfortable part of my labour it enabled me the most precious time with my ds. This was because I had requested the cord be left until the placenta was out- so he stayed in my arms for his first 40 minutes. There was no great amount of bleeding (in overall postpartum bleeding seemed easier and less than with my 2 managed 3rd stages).

One thing that I was absolutely adamant about and think anyone having a natural 3rd stage should be - is that the midwives were not to pull on the cord at anytime. This increases the risk of things breaking down before they come out and ending up with retained tissues and infections etc.

I'm undecided about doing it again this time around.... it was blooming uncomfortable but there was an easier pp bleed.... hmmm.

[redtent]

eta- my request to have the cord left on DS was primarily because ds1 and ds2 were whisked off, weighed and given back to me dressed... very little skin to skin etc.

DS 3 was left skin to skin for his first 2 hours (apart from a nappy!).

[PavlovtheForgetfulCat]

i just posted about this on another thread. Not read the other posts yet, but I will in a second.

I had managed third stage last time, and retained placenta which needed manual removal and am due to give birth any day now. I have specifically requested a natural third stage as i beleive this will reduce the risk of the retained placenta. I am not saying the retained placenta was caused by the managed third stage, but I beleive it did not help.

If there is excess bleeding, or the placenta is not delivered naturally this way, it can be managed at any time with oxytocin, it is not a case of have it straight away or not at all. Although the Drs will have you beleive otherwise.

Just make sure you have clearly written in your notes that you wish for a physiological third stage, the cord not to be touched and to breastfeed immediately. Large letters and remind them when you get to hospital that you want a midwife who is experienced in natural third stage delivery.

[PavlovtheForgetfulCat]

bertie you are right as far as I know - the risk of retained placenta is increased with managed third stage for the reasons you state - the window to remove the placenta is much much shorter as the uterus starts to contract immediately.

And a managed third stage is most usually encouraged as it is easier for the hospital, if it comes out straight away it is very simple and quick. And excuse my cynical head, but means you are able to get cleaned up and off the labour ward more quickly. Not suggesting this is the reason they do it of course [wink[ but certainly a positive side effect in their mind. Also, midwives are generally less experienced at natural third stage, but as long as you specify your wishes clearly and loudly, they will ensure your midwife will be experienced in this, even if it means bringing in a midwife for that bit.

[slushy06]

I had a managed 3rd stage on both ds and dd I choose this simply because once the babies were born I didn't want to faff about with the placenta I wanted to concentrate fully on my baby and bf and I heard someone say you still get cc if you have a natural 3rd stage not sure if it is true. Placenta delivered in 2mins easiest thing in the world.