Managed or natural third stage

[EauRouge]

Morning

I am expecting DC2 in a few weeks and planning a home birth. With DD, I wanted a natural third stage and was allowed to try for an hour (with no result) before MW and I decided to go for the jab and cut DD's cord.

This time I am wary of blood loss because I will be at home and so I'm wondering whether to just go for a managed third stage, whether I will be allowed a combination of both like with DD or whether I should try for a natural third stage again. It's very important to me to let the cord finish pulsing before it is cut.

Has anyone got any words of wisdom or experiences to share? TIA.

This is something that I considered at length with all my dc. Apparently it is now more common for the cord to be left to stop pulsating that a few years ago before administering the sytometrine. There is a brilliant booklet on managing the 3rd stage by AIMS (I thing it stands for the association for improvements in maternity services and is available online) which might help.

I would go for a combination of both, sytometrine can be given at any stage so if it looks as if you are bleeding too much or it is taking too long then it can be given. you may of course be absolutely fine and have a natural 3rd stage, and this is far more likely if you are relaxed and put your baby to the breast which is all easier at home.

I had a managed 3rd stage with dc1 which resulted in a haemorrhage and retained placenta. With dc2 I had a natural 3rd stage, it took just under and hour for placenta to come out with minimal blood loss. With dc3 I had a managed 3rd stage (although I had hoped for natural) as I was bleeding heavily and it all went well.

Hope that helps

Thanks, that is really helpful. I've found the website and I'll have a good read of the article tonight once DD has gone to bed.

I agree with greenbeanie - if you have a natural 3rd stage and you begin to bleed heavily your midwife will simply give you the jab and the bleeding will stop within moments.

If you have a natural birth why go down the medical route for the easiest part?

Remember if you breastfeed your baby as soon as you can, this will help the placenta be born safely.

I had a homebirth with no 'pain' relief because there was no pain. Really wanted a natural 3rd stage to follow, so the midwives put a bin bag in my toilet (to catch the placenta) and I sat on the loo breastfeeding and cuddling my new baby, it was great!

Even when the chord stops pulsing it is giving your baby nutrients, and will do for days if you leave the baby attached!

Your midwife will certainly bring syntometrine along with her.

Good luck!

there was a thread about this..though the verdict seemed to be - if birth is intervention free - natural with synto on standby

i'm preparing for my 3rd home birth and my last 2 were v.v. similar - the placenta came out after 15 mins both times (i hadn't started feeding yet) so chances are you're going to have a v.similar scenario to your 1st birth, with the benefit of hindsight.

after discussing it with my mw before ds1 was born she said i could have an hour or so (can't remember exactly) to allow natural 3rd stage and would have the drugs if necessary.

Thanks everyone. I think I'll go for a natural third stage and see how I do, if I'm really tired I might put a time limit on it. I had such a long labour with DD I was begging for a managed third stage after an hour because I just wanted a break! DD was straight on the breast as well. Fingers crossed all goes well!

EauRouge - a passive third stage is an acceptable way to deliver the placenta and in a homebirth where everything has to have been uncomplicated, it is very likely to be fine. It is important to remember that worldwide bleeding is the commonest cause of maternal mortality because they do not have 'managed' labours.
I am interested to know why it's so important for you that the cord be left to stop pulsating? Do you really think it makes much difference for a healthy term baby?

It is worth bearing in mind that although postpartum haemorrhage is a major cause of maternal mortality much of the research is carried out in developing countries. It does not factor in the number of pregnancies ( often very high) and the level of antenatal care that these women are given, again often lacking in quality and quantity.

Therefore applying it to a watch and wait natural 3rd stage where there is access to medication should it be needed is unlikely to increase the risk of haemorrhage.

I had managed 3rd stages for 2 of mine (all active/natural labours) and a so-called "natural" 3rd stage with my middle child. Well, it was easily the least natural part of any of the 3 labours...of course it was taking a while, midwives were getting twitchy to say the least and did I not end up having a catheter put in (only v briefly thankfully) to drain the bladder in order to get the flippin placenta out.

The other 2 times it was over so quick i can't even remember it (though that was possibly to do with being out of it on baby-love and gas and air!).

Good luck whatever you decide!