Injection for third stage

[thereisalightanditnevergoesout]

I wasn't sure whether to post this in childbirth or Pregnancy.

I am expecting 4th baby any day now - and hoping for a homebirth.

My midwife has told me that, although I delivered my placenta naturally on previous occasions, this time she is likely to give me an injection to help me to deliver it this time.

The reason she has given me is that I'm more likely to bleed heavily if not (and it would be a shame to end up in hospital after a homebirth) - as the more children you give birth to makes this more likely (the heavy bleeding, not the ending up in hospital).

I am more han happy to do this. I completely trust my MW - she is very experienced.

I did have to go for a scan at the local hospital last week to check the baby was head down (he has been breech, and was successfully turned by ECV). The Doctor I saw there (perhaps not an advocate of homebirths) seemed less enthusiastic about our plans and worried me a little about the potential bleeding after birth. She wasn't completely negative - but managed to say enough to make me doubt that my decision for a homebirth is a sensible one.

So I'm hoping someone may be able to reassure me with regard to a managed third stage after having 4 babies.

I had the opposite. Gave birth to no 6 at home, it was my first natural third stage. Midwife said it would be fine. and encouraged giving it a go. She was a very experienced midwife. I knew her of old and trusted her views. Infact placenta came out very quickly after the birth. I did bleed a lot come to think of it, but was fine. Good luck

You can always try natural 3rd stage and change your mind and have injection.

Can you? I really have no idea - though I though I read somewhere that the injection needs to be given as the baby's first shoulder is born.

But that's what you get for googling!!

Will have a chat with MW.

Hospital consultants are usually skeptical about homebirth. That's to be expected.

My story:

HomeB with baby 3: I tore badly from bad positioning (squatting) as baby was born (I strongly recommend standing for delivery, btw) and had excess bleeding over all, so transferred into hospital after the birth. Placenta was also slow to appear, so they gave me the jab eventually at home and then it came out fine. In hospital they found my iron levels were fine and sent me home with only an iron tablet prescription (which I never used).

Baby 4: another Homebirth and I conveniently neglected to tell them that I had been transferred the previous occasion. Baby born at home, natural 3rd stage, very little bleeding, placenta took ages but eventually appeared after I walked around a bit (I definitely recommend moving around to get the placenta to let go).

So I was supposedly at risk from bleeding too much at home for baby 4, but that didn't happen at all because 4th baby was a standing delivery, and I had good mobility to help get the placenta out.

Perhaps there are things in my story to help you feel more informed how to best manage? I'm always afraid with the managed 3rd stage that the placenta won't appear in the 10-15 minute time window and then it's a guaranteed trip to Operating Theatre -- No thanks.

Good luck, whatever you decide.

'I'm always afraid with the managed 3rd stage that the placenta won't appear in the 10-15 minute time window and then it's a guaranteed trip to Operating Theatre'

Yikes.

I had a managed third stage with DC3 and was given 1hr for the placenta to arrive, it finally did after an hour of grunting, and eventually a catheter... Eeek!

Oh blimey.

Beginning to wish I hadn't posted now...

I've had 3 homebirths here and 3 natural placenta deliveries. With the second one, the midwife used a pressure point on the top of my shoulder and that seemed to do the trick.

Most doctors , by the very nature of their job will be sceptical about homebirths.... they only see the births that need interventions after all.

Good luck with it all.

Yes - I suppose you're right - and our local hospital is a university/teaching hospital too so naturally quite interventionist.

It just seems a bit scary that, in order to avoid going into hospital for a heavy bleed, you end up being injected with a drug that might mean you have to go in to hospital to be operated on.

I've had 2 homebirths now - and I did notice that I bled considerably more after 3rd baby than I had with the first or second birth.

As I said I bled loads with dc6. But only after everything was cleared up and the midwives had gone. I remember thinking that there was a lot of blood. But it was very short lived and I didn't feel ill with it.
Of course it's entirely up to you. Do what you feel comfortable with.

It's difficult to know what to do, really.

I think I'd better get chatting about it. I do remember from last time, DD2 came up on the bed to see her new brother and pressed on my tummy and lots of blood flooded out - which wasn't nice.

I would try and garner the opinions of the senior midwives at the hospital. NOT the doctors tbh. Get is from the women who've assisted all sorts of births, doctors only go to the troubled ones, their views are distorted.

When expecting my third I was hoping for a vabac after 2 sections. It hadn't ever ocurred to me I could not try. All midwives were perfectly happy with this. When I had a routine appointment with a consultant at 36 weeks he berated me for even contemplating a vbac.

I was distraught. My lovely doula arranged for me to talk to some senior midwives at the hospital. They were brilliant and put it all into perspective. They hinted that that particular consultant had issues about vbacs
I went on to have a lovely vaginal birth.
Forewarned is forearmed. Do some research, ask questions then make up your mind.

I didn't realise with DC1 that the injection was optional.

With DC2 I read up on it, there is a little info here and decided not to have it if possible.

The MW read it in my birth plan, had a quick chat with me and we agreed that she'd get the injection ready, just in case. I delivered it fine in about 10 minutes without the injection while DH got some lovely skin-to-skin with DD.

I had a natural birth and always just assumed you had to have the injection. My MW said it would be a shame to take drugs at this stage so applied a clary sage soaked pad to my tummy and 15 mins later placenta came out!

The MW who will deliver this one has delivered all 3 of my DCs. She is a Senior MW and a relative - so I trust her. I think the issue isn't do much getting the placenta out (they've always come out easily as I recall) it's more to do with the bleeding afterwards - not sure what causes the bleeding (just a worn out uterus, maybe?). Thank you for the link - I'll have a look and read up as much as I can to make an informed choice.

I really appreciate your input and advice and hearing your experiences.

Thanks for the link.

Well, that's explained quite a lot.

Having had 3 natural 3rd stages - I can see the benefits of those, but I can also see why a managed 3rd stage is recommended this time. MW knows my history - I have very speedy labours, this one is likely to be a big baby and as it's my 4th, I'm more likely to bleed more heavily - so all in all, I think MW's suggestion is fair.

I never have managed to feed any of my babies before cord is cut - DD1's cord was very short, and from what I recall, there wasn't so much time before placenta was delivered at births 2 and 3. Also, I seem to remember being absolutely exhausted and didn't actually hold any of them straight away (I remember kneeling at the end of the bed looking at DS lying on the bed, but was too wobbly to move or support myself, let alone pick him up to hold him).

So as long as there's no risk to the baby - and I'm happy when I've talked it through again, I'll probably go the managed route.

Thank you again for all your posts!