Managed Third Stage and Rhesus Status - Advice Please!

Ali P - why do you want a managed third stage? Why not see how the labour goes... you may not have a choice anyway as Mears said... and if you have a problem/drug free labour, why give your body some drug (artificial hormones) at the last minute?
Just trying to understand why you feel this way?
Thanks

Leese - I don't know... you tell me
oops just realised as I type... NO I AM WRONG
They are Rh-.... of course...... silly me!

Just a quickie pupuce - why no anti-D if you're RH Neg, and baby RH pos?

Khara - Yes I have heard that: I was told that the risk is only increased if the injection is given too promptly, and anyone concerned about this should ask the midwife to delay the injection slightly. In my case I had a retained placenta with ds2 because the cord snapped . With both dd3 and dd4 I was therefore advised to opt for a managed 3rd stage but with midwife manipulation of my tummy rather than pressure on the cord. Im sorry, I realise this probably leaves AliP more confused than ever!

AliP - Mears advice earlier looks like informed opinion to me - hope it helps!

To Gilli - did you know the chances of a retained placenta are increased with a managed third stage? If the placenta is not delivered within the time taken for the Syntometrine to take full effect it may become trapped inside as the cervix contracts back.

I nearly had a retained placenta with ds2. It took over an hour to emerge, despite the Syntometrine, and I had by far the worst contractions of my labour in the third stage. Only because I was at home with a very confident midwife, was I allowed so long to deliver it. She was actually picking up the phone to ring for an ambulance when I got a huge contraction and out it came. Next time (if there is one) I would definately try for a physiological third stage.

Sorry - I never heard anything about being Rhesus neg and its implications for the third stage.

I am RH - : had a first labour with syntocynon at the end so had to have a managed third stage. However baby is RH +
and with second baby: labour "au naturel" and so physiological 3rd stage... again Rh + baby...
so never given anti-D

Yes thanks Mears. I'm RH neg too and both times have had a managed third stage.

I'm Rh- and had a managed third stage with an Anti D injection a few days later when they found out what blood group ds was (B+). It was never mentioned to me not to have a managed third stage. Thanks Mears for explaining the whys and wherefores.

The theory is that a managed third stage encourages a larger fetal maternal transfusion ( mixing of mother and baby's blood) as the placenta separates because the placenta is more engorged with blood and is forced to separate earlier because of the oxytocic drug given to shorten the third stage. A physiological third stage means that the separation takes place when the cord has stopped pulsating naturally and therefore the placenta is not so engorged with blood therefore reducing the amount of blood able to enter the mother's circulation.
This is a theoretical risk. As you are not opposed to having anti-D this is not so much of a problem. After delivery, as well as the baby's blood group being checked from the cord blood, a sample is sent from the mum for a Kleihauer test to be done. That measures the amount of fetal cells that may have crossed into the maternal blood stream. If it is greater than 0.4ml then the dose of anti-D given is increased to make sure that no antibodies can be produced.
A physiological third stage is absolutely fine if you have a labour with no interventions. If however, you need to be induced or have an epidural or assisted delivery such as forceps or ventouse then a managed third stage is recommended, rhesus negative or not. Hope you can follow my ramblings - have just finished a night shift and am heading off to bed.

I'm Rh- and had a managed third stage. I was given anti-D a couple of days later, after they had checked ds's blood group. I have never heard anything about not having a managed 3rd stage if you are Rh-. The idea of the anti-D is that it destroys any of the baby's Rh+ cells that get into your bloodstream, before your own immune system has a chance to make antibodies. The anti-D has to be given within a certain number of days. I can't see why having a natural third stage should make any difference to this (and I used to be an immunologist, but very rusty now).

HTH

AliP - I have my sister with me as I type (!) who is Rhesus negative and mother of 4 aged between 11 and 1. She had anti-D after each delivery, and the injection for a managed third stage. Was never warned not to, and the outcomes were good in each case. She says follow your doctor's advice is best. For my own part, I had a retained placenta with one and its not a pleasant experience so on balance would recommend a managed 3rd stage. HIH

I haven't heard anything about the third stage bit but with my 1st labour i wasn't given the anti-d.Told they would wait until baby born and check his blood depending on his group as to weather or not they would give it to me.Never had it with him. Had it given with the second as i had bleeding throughout pregnancy due to placenta previa.

not much help am i sorry