Can you have a physiological 3rd stage with ...

[nappyaddict]

Induction, G&A, Pethidine, Epidural, Episiotomy, Forceps, or Ventouse or do you have to have syntometrine?

I think certainly with induction pethidine you must need syntometrine

anything that might affect the wombs ability to contract would contraindicate a phys 3rd stage

can't see why episiotomy forceps or ventouse would make a difference

not sure about gas or epidural.

we need a midwife to answer this! I'm just guessing

ps had two physiological 3rd stage in my home births. 1st one lasted longer than labour (but it was a short labour)

shook and vomited with the other two syntometrine ones. but those were both in hospital and induced

If G&A only, then you can have a physiological 3rd stage.

Pretty sure it's definitely syntometrine for all the others you listed.

I know someone on here who had g&a and low dose epidural and had natural third stage. I asked mw at antenatal class if I had an epidural if that would mean I needed injection and she indicated it didn't automatically, although, if it took what they consider too long or I started bleeding alot then they would do give me the injection.

generally, if you have anything other than a spontaneous, drug free birth, you will be recommended to have the syntometrine.. this is because is an induced/augmented/medicated labour, you are interfering with the natural flow of hormones .

there is a greater risk of PPH with induced/augmented and assisted delveries hence the recommendation for synto

I had an induction with physiological third stage, although I only had my waters broken. I was told if I needed the drip I'd need the injection.

I was also told I needed the injection when I was being induced with the drip (ended in EMCS so didn't matter in the end)

I actually threw a big strop over it because it was having that damned injection (natural, precipitous labour, G&A only) that left me with retained placenta and post partum infection two weeks after the birth of my first, and three nights back in hospital on an IV. I have spoken to several midwives since who have all said that with a precipitous labour, the injection is not recommended for this very reason as the uterus is too exhausted or something like that. Naturally I didn't want a repeat!

They understood my concerns and went and talked to loads of doctors/midwives before coming back and telling me I really, really did need to have it. As I wasn't expecting to be induced I'd not had time to look into it, but I accepted it eventually. This was at Kings College so I'd guess their consultants would probably be right.

bitingfairy Did you have the pessaries for your induction?

lulumama Does that include G&A?

You can have a mix of the two, waiting for the cord to stop pulsing before you have the jab so you at least know that the baby has all the blood.

I can't see why you wouldn't be able to have a physiological 3rd stage in anything but a section (section can be mixed) as you've had the contractions to get the baby out. I've seen a lady not have the jab and her contractions stopped, she coughed the placenta out.

The jab is the only thing in the UK that's not elective, they're not allowed under NICE guidelines to ask if you want it, it caused so much uproar that the NCT representative at NICE quit. It is supposed to stop you from having a PNH but what you don't lose at the time of the birth/ shortly after is just going to be lost in the following 6 weeks. It's been found that you lose the same amount either way just one is straight away and one is over time. We also have quite a low threshold for PNH in the UK compared to other countries.

no, that does not include gas & air .

Had syntometrine and retained placenta with DS
(1st birth). I had no problem physiological 3rd stage after having my waters broken (no other induction) and gas with DD (2nd baby). .

Like the others say above, anything that might effect the labour hormones (epidural) and/or your chance of haemorraging (very long labour, induction with a drip, episiotomy.) should consider the injection. Not sure about pethedine/diamorphine but usually better to have physiological after an intervention free labour.
Selina

Is it just with syntometrine where you have more chance of a retained placenta or is it the same with the syntocin jab?

I didn't have pessaries as I was already 13 days over so they were able to just break my waters.

confuddledDOTcom: You really are confuddled!
The NICE guidelines do recommend the active management of third stage with Syntometrine or Syntocinon but they do not say it cannot be discussed. As for the injection not being elective - that is nonsense. Your theory regarding the amount of blood loss is dubious. I think you need to reconsider the physiology of third stage.

For the OP: G&A or Pethidine alone should not rule out a physiological third stage. The other interventions are interfering with the normal flow of labour so an injection might be recommended. The concern is that your uterus may not contract as effectively after all the intervention and if it is atonic (not contracted) then you would bleed. Nothing to stop you negotiating with the staff though. "Wait and see" is a handy phrase!

That's what I was told by a couple of people, seperately, from NCT. Maybe that's what the discussion was and it was never agreed.

Which bit about blood loss is dubious? The fact we survived for thousands of years without injecting women?