Birth plan question - any midwives about?

[JetLi]

I want a delay in cord clamping/cutting & third stage generally. I have been reading up and found what looks to be a halfway house between active & physiological third stage which the NCT called Delayed Active Management. So the article I read says this would delay the synt. injection plus any clamping, until after the cord has stopped pulsing.
Is this a familiar phrase or do I need to provide more explanation in my birth plan do you think?
Many thanks

I put that in my birth plan first time round. I think I just wrote that I wanted to wait until the cord stopped pulsating to have the injection. In reality I was so knackered I didn't care enough and had the injection! Good thing I did as it turned out I had a retained placenta and the dangling cord was hiding a 3rd degree tear!

The term is 'physiological 3rd stage' ie the cord is clamped once it has stopped pulsing and then you wait for the placenta to come out naturally. My midwife said that if you are going to have the injection it has to be straight away, so you can't have it if you're waiting for the cord to stop pulsing.

hopefully someone else will be along soon to clarify things.

A true physiological 3rd stage is where you do not cut the umbilical cord, and birth your placenta whilst baby is still attached, there is actually less chance of a retained placenta with a physiological 3rd stage.

Most people do have syntocinon or syntometrine and often this is given as you are birthing your baby, if you do not want the injection make it very clear on your birth plan.

If you think that you would like to wait for the cord to stop pulsating and then go on to have the injection that is absolutely fine (there is not time limit of how long after birth you can have it) and can prove to be a good mix of ideas (as you have already said).

To be perfectly honest I would just write that you would like a physiological 3rd stage and the cord is not to be cut until it has stopped pulsating. (even if you know you may want the injection)

I guess it may just make it easier when the midwives are scanning through your notes/birth plan if things are almost kept to simple bullet points.

HTH

Thanks homebirthmummy - trying to get 4 or 5 main things crystal clear on the plan so I think you're right and that would be the way to go.

The placenta will come out soon after the cord stops pulsating anyway so why why bother with the syntometrine? Unless you're bleeding theres no need for a halfway house.

That's true Cathypearl, although if after waiting an 1/2 hour to an hour for it to appear you are fed up with a dangly cord then there is no reason why you can't have it.

By the sound of it, I think OP has looked at all the benefits and risks and has decided on a course of action which suits her best.

If you ask me why bother cutting the cord at all, any one for a lotus birth?

i had the injection an hour after the birth as the placenta wasn't coming out and the mw was worried my cervix was going to close. she also wanted to check me for tears. my birth plan stated that i wanted delayed clamping and a physiological 3rd stage but may consent to the injection after the baby has been born, in case of heavy bleeding or placenta not coming out - which is what happened.

It's very rare to find a mw comfortable with a fully physiological 3rd stage (i.e. birthing the placenta before the cord is cut). There is no reason for this except it isn't how they are used to doing things.

Your compromise sounds fine, BUT again it is fairly rare and some midwives haven't had recent experience. I have heard too many stories where they have NOT given the injection but treated it as if they have i.e. tugging on the cord.

No tugging must occur. This is what increases the riskof PPH.

The injection itself carries a high risk of retained placenta.

sorry, the risk of a retained placenta is NOT high, but it is higher than if you were to have a physiological 3rd stage.

Thanks again folks