PPH and third stage injection

[mummyjah]

Dear all,

I've posted previously on this but thought I'd open this up for general comments.

I have had three fast labours. My last one (went from couldn't feel contractions to feeling need to push quite quickly - second stage lasted one minute) resulted in a PPH (I remember having an intuitive feeling that this uterus was not going to contract on its own after that!). I have since spoken to a highly rated consultant who said that this was because the midwife insisted on following my birth plan for my request for a physiological third stage. My uterus was atonic and according to the consultant, women with precipitous labours should ALWAYS get an injection to contract the uterus because the uterus will rarely contract on its own. According to two consultants I've spoken to about this (both very highly respected), a retained placenta happens independently of the third stage injection. I can see the logic that an atonic uterus will not contract on its own. However, several posters have been told the opposite. Thoughts, please?

My first was a fast labour. I had the injection. They had to pull on the placenta to get it out in time, as my uterus was not even slightly interested in firing anything out!

Two weeks later I spent three nights on IV antibiotics with infected retained products.

Midwives I have spoken to have said that the uterus is just too exhausted, even with an injection, to expel the placenta after a fast labour so it should be allowed to do it in its own time.

I had a severe PPH (3 litres+) but wasn't a quick labour and did have the injection. Research via Google recommends the injection as going the physiological route increases the risk of PPH.

In my case my uterus wasn't contracting in addition to significant 2nd degree tear. I did not have a retained placenta and from what I understand it is normal practice to apply pressure to the cord to remove it following the injection. My PPH could not be foreseen and I don't fit into any of the risk categories described on the internet - it was just one of these things.

It's too easy to second guess why things happen. I would go with the advice of your highly regarded consultants over anything you read on here (much as I love MN!).

Mine was a very quick labour and I gor a retained placenta (no PPH), with DS I requested a physiological 3rd stage and was told as my placenta was stuck to the lining of my womb (scar tissue) then the injection wouldn't have made any difference and it was recommended I have it as if the placenta retained again it would be realised and dealt with sooner with the injection.

Didn't get that far as DS was born by EMCS.

Should have said I was going for injection as I had faith it what the Consultant told me as I am no expert when it comes to having babies. And to be honest had never even heard of a retained placenta until it was happening to me.

If you have had a previous PPH I would recommend an active 3rd stage next time but syntometrine will not prevent a PPH by any stretch of the imagination. Every PPH I have every been involved in has been after active management of the third stage! It is certainly anecdotally linked to a retained placenta as the danger is that the cervix closes and traps the placenta behind it.
The definition of an atonic uterus is one that will not contract and certainly with the fast expulsion of the fetus from the uterus one could make a logical connection to an atonic uterus but no-one can predict the future so we don't know who will and won't have a PPH in advance.
Having said that, it is absolutely your choice how to manage your labour and delivery of the placenta, a physiological third stage is shown to have a higher blood loss at delivery but less over the following days and weeks, it is not linked to PPH in normal labour. (Whether a precipitate labour such as yours is 'normal' is up for debate!)

Thanks for all of your responses. I will certainly be taking the consultant's advise but what concerns me a lot is the seemingly contrary advice that women received from medical staff. I think that this is a big issue. After all, if some medics recommend an active third stage and some physiological, how can non-experts (i.e., labouring women) decide?

Heh, yes - I agree with you. Sadly it's not the only thing medical people disagree on. I've heard so many contradictions over so much in all three of my pregnancies. The last two have been high risk and every appointment I see a different consultant who disagrees with what the previous one said.. often on the same team.

It's a minefield. Usually I just research for myself if it starts getting too silly because often doctors aren't up to date with the latest information. Although sometimes it's just down to opinion and personal experiences of the medical person in question.

It shouldn't be that way, but it is.

The injection is a moot point for me these days as I have to have c-sections - I have to say I am glad the decision has been taken out of my hands!