Anyone had a physiological third stage??

[karmamother]

I'm planning to have a physiological third stage & I'd love to hear from other mums who've had positive (& negative) experiences. Also, how long did it take to deliver your placenta?

but what is it for if it's not for stopping the bleeding?

Beartime, I think the difference between these 2 drugs is syntocinon mimics the naturally occuring oxytocin we produce anyway, & therefore contracts the uterus in that way. Ergometrine causes a rather more stronger, more sustained contraction which also closes off the cervix as I said earlier. I've just been looking at a website with a trial on it comparing the injection with both drugs in it to the one with just synto in. The was a slightly lower incidence of pph in the group who had the 2 drug injection, but nothing to greatly increase maternal morbidity.

oh ok, thanks. Still slightly confused, but I suppose I don't really need to know everything do I, thank goodness!

ergometrine is also the bit that makes you vomit afterwards - nice!

Active management of the third stage is a very interesting subject. Ergometrine originally was used to control haemorrhage after the palcenta was delivered. Then doctors decided that since it was good for that, then lets give it to speed up the delivery of the placenta. As drugs were developed through time, syntocinon was developed and the drug syntometrine was used routinely for the delivery of placenta. The theory was that if the third stage was shortened then haemorrhage was prevented. That statement is not entirly true.

In a totally physiological labour, the placenta will deliver on it's own. There is usually a greater blood loss at delivery but less in the following postnatal days. In active management there is less blood loss at delivery but there is much more in the days following as the uterus relaxes as the drug wears off. Many women have had the experience of going to the toilet and feeling a flood of blood pour out in the first few hours after birth.

Where a labour has been interfered with by using opiate pain killers, epidurals, induction - the third stage should be actively managed because the natural flow of labour has been interfered with. It is possible to wait and see what happens post delivery. If bleeding starts, the injection could then be given and the placenta delivered.

The ergometrine component can lead to retained placenta. Syntocinon on it's own is used in may units. The problem is that it is unlicensed by the drug company for intramuscular use (IM). It was originally designed for intravenous use. However, it has been used safely and effectively for many years. The drug companies will not finace a costly trial to find out what is already known. As it is unlicensed it requires to be prescribed in law by a doctor. This is a problem legally for midwives where the hospital pharmacist will not allow midwives to administer it on their own authority. Midwives can do that already with a number of other drugs.

I believe where possible women should have physiological third stage (physiological labour). If it needs to be managed the syntocinon is my preferred drug. I have seen too many women have the first minutes with their baby ruined by vomiting - a side effect of ergometrine.

this is a good article explaining it all

Thanks Mears, your input has been really useful. I've been trying to expain benefits of a natural third stage mt DP so he can support me more fully at the time, so its good to have more up to date facts. I understand that it may be contraindicated but it's good to know I can ask the MWs to wait & see before progressing to active management. Where I'm going to deliver they give meptid & whilst I know its not in the same league as peth/diamorph will this prevent me having a natural 3rd stage?

You can always use the wait and see theory. Drugs (even meptid) can have an effect on labour. If however, labour progresses well after meptid has been given then there is no reason not to delay active management until needed ie because of bleeding or placenta not delivering (which as said before can take a long time. Our cut off is 2 hours).

Wow am I just mega lucky? I had a physiological third stage with my second and the placenta was out within 5 minutes, and I lost 250 mls of blood.. Another thing to add to my list of 'why this labour was better than last time'!

I ended up having one through necessity as my bp rose sharply in labour. One hour after delivery my placenta still hadn't arrived and the ob had to put his hand in and yank it out. Yuck!

They said the problem was that it was so large and strong. When it came out, he said it looked like it could have lived for another month at least.

I had one too, following a hospital water birth. I think it took about 10 mins. I just remember handing dd to dh. The midwife drained the pool and I just sqatted over a tray thing. No probs!

Mears, does a labour count as totally physiological if you've used gas and air, or does it mean without any pain relief at all?

Harrizeb, my midwife definitely waited until the cord had stopped pulsating before clamping, but my dd was still a bit jaundiced.

Littlefish - gas and air does not affect the progress of labour ie does not slow down the contraction. So yes, it is still a physiological labour. Injections of painkillers can interefere with the contractions themselves..

Thanks Mears.

Thanks for this mears, I am planning to have a physiological third stage with this baby when I asked the midwife about this all she said was "it prevents haemorrhage!" and that was it.

It is interesting to note that it can be given if haemorrhage is looking likely (is this the case) I wonder why they don't give more women the chance to deliver without the injection?

Last time it took just under an hour to deliver the placenta and they were threatening me with surgery and a manual extraction (think I mentioned it somewhere on here) hovering over a bedpan and having a catheter inserted to try and deliver the placenta was a bit traumatic especially as I had had such a straight forward labour. DD was delivered onto me and then DP had her for over 2 hours whilst all this was going on trying to deliver the placenta and then the stitches. I felt this crucial time in her life was denied to me a bit. At no time did anyone say I was having trouble delivering the placenta because the ergometrine may have closed my cervix and thats why they had an hours cut off. I also had a lot of post birth bleeding with huge clots coming out for a few days afterwards.

sweetkitty, I think it's been mentioned on here before but I suspect that a lot of MWs don't offer a natural 3rd stage as it takes longer & also there's sometimes more bleeding at the time. Compare with an actively managed one where it's usually wrapped up in 10 min & bleeding slows down soon after. I was interested in Mears post where she said that with a natural 3rd stage there is often more bleeding at the time but in the subsequent days it is much less. Quite a few of the Due in Nov MNers who have delivered already are still bleeding after 3-4 weeks & I think they had actively managed 3rd stages. I know this isn't conclusive but it's food for thought.

I had a physiological third stage with ds3 a couple of months ago. He was a home birth - actually born in the bath (which was being emptied). It took 30 minutes to deliver the placenta (large apparently), which was half the time of labour! The MW cut the cord after the birth though, not sure why she didn't wait till the placenta delivered. I was getting impatient waiting for the placenta, so went and sat on the loo (after putting the tray thing down it), and sure enough as soon as I sat down it came out!

Natural 3rd stage I'm pretty sure - an absolute non-event to me though perhaps not to the midwife! I had a borderline pph which meant i had to be signed off by a doctor before I could leave the hospital, but bleeding afterwards certainly was a lot less than I was led to expect. although there was one large blood clot, the emergence of which was the strangest moment of the whole birth - it felt like being a pinball machine and it rattling through all the complicated bits inside. Sorry if TMI!

I had a phy 3rd stage and I don't know if it's related but DD was in SBU for 7 days as she was polycythaemic. This is where blood from the mother floods into the baby making her blood very thick. She had to have her blood diluted (a tricky procedure) and it was very worrying.

When quized by the Docs I never mentioned this phys 3rd stage and it is only now I am wondering.

I'm off to google....

Have just read all this stuff and found it really interesting and empowering, so thanks loads. Can I just ask, if I don't breastfeed, will a physiological 3rd stage be more difficult? I am planning to have a waterbirth at home and would prefer not to bf as I have a spinal injury which means that I'm unable to sit/stand etc for long periods of time in the same position. This is something we have planned to share between us. Also, one of my mw's says it's fine to deliver the placenta in the water, whilst the other one says it increases the risk of water embolism (I think this is the phrase she used) Which one should I beleive? I would be happiest to have as little intervention as possible, but would not like to endanger the baby or myself. Thanks in advance...

shinyshilling, I'm sure you can have a succesful 3rd stage without BFing. But, have you considered putting baby to the breast solely to help the placenta deliver? It doesn't mean you have to continue but you could use the mechanical/hormonal effect of latching baby on to help you. You can do it in the pool when you're both supported by the water.

As for the MW's conflicting advice, I think they have to point out the pros & cons so you can make an educated decision. However, a sweeping statement like "it increases the risk of water embolism" isn't terribly helpful. What are the statistics?? If you need to know more, try starting a thread & seeing of mears can help. Good luck.

Shinyshilling my baby wasn't breathing when he was born and delivered the placenta naturally while he was being resucitated, so I wasn't feeding him when it was delivered so it is possible.

He's fine by the way, didn't mean to worry you, he's lying on the floor swiping at an elephant as I type

was very annoyed at my midwives as i had a completely natural birth and had wanted a natural delivery of the placenta but in the confusion of my dd's arrival and resusitation (the cord was around her shoulder which hadn't been noticed til she was half way out) the midwife injected me with the jab before either i or my partner noticed.

i subsequently suffered massive haemoraging which took hours to bring under control and several days later a massive chunk of retained placenta came out and the pain and bleedng immediatly lessened.

i honestly believe all of this would have been avoided if i had been allowed to deiver naturaly like i had planned, advertisment for a written birth plan!