Planning a physiological third stage but worried about heavy bleeding

[lovecloud]

Hello

I am pregnant with second child.

With my first labour I did not have a physiological third stage and shortly after I started to bleed so heavy it came out like a hose and covered the bed. It was very frightening and I had to changed my clothes three times within a hour and passed a bloodclot the size of a large orange and two more like satsuma size.

My midwife said it was because I pushed for two hours with a full bladder but I am not sure?

I spoke to a midwife who encourages natural labour and she suggested I should have a physiological third stage this time. But I said surely there is more chance of bleeding heavily this way. She did not agree and said that I probably bled heavily first time because the midwifes like to hurry the third stage and push down and tug at the cord which causes bleeding.

I would like to hear your comments on this?

If you had a physiological third stage, did you bleed heavily?

This is the one and only thing that frightens me about childbirth. If someone could promise me that one way or the other wil dramtically reduce my chance of not bleeding than i would go with that way and enjoy the experience of giving birth.

i think your midwife is right!
i am no expert but her explanation sounds pretty good... that if your cord was tugged out it would have pulled the placenta away causing the bleeding

i don't think you can be certain either way that you will or won't bleed. but i know a few people on here have had a physiological third stage and it has been absolutely fine!

Hi Lovecloud. I'm not an expert - hopefully mears or another wise person will come along soon! - but I can tell of my own experience. I had a very long pushing stage (5 hours...) and was not allowed my planned physiological 3rd stage, but subsequently had a huge bleed resulting in my needing a blood transfusion. The doctors were really keen to make sure I understood what had happened and why, so I do feel that I got a good explanation. I was told that the uterus is a muscle like any other, and gets tired like any other. If you have a long 2nd stage it is relatively common for the uterine muscle to be too 'tired' to clamp down quickly enough to prevent this heavy bleeding. As a result, under those circumstances a physiological third stage was not allowed as the drugs were needed to augment the natural contracting power of the uterus, and they also massaged my uterus through my abdomen to stimulate contraction. This is the complicated version of what your first midwife said!
I think your other midwife may possibly not have understood about the circumstances of your bleed... (Trying to be charitable here!)
If I had another long labour I would definitely opt for the drug, and in fact will probably go for that as a default option anyway. I am prone to becoming unwell when I lose even a small amount of blood, so better safe than sorry for me!
Could you arrange to speak to a midwife at the hospital where you had your first baby? They would be able to go through your notes with you and explain what happened and why, and hopefully that may answer your questions and set your mind at rest, and help you decide how you want to proceed this time.
Hope this helps.
JennyWren

Forgot to add - even with all the intervention, it still wasn't enough for me and I had the bleed anyway! But usually that would have been enough, and they were expecting it to be in my case too. There always has to be an exception.. I like to think of myself as special

lovecloud, I had a physiological third stage with both my boys and do not remember bleeding heavily. I have to admit that I hadn't been pushing for long at all really (30 mins with DS1 & a couple of pushes with DS2) so I don't know if this makes a difference or not. Obviously, there was all the usual blood and gore but I don't think it was anything excessive. I think it took about 20 mins but I'm not exactly sure, the whole thing is a bit of a blur really (except for the pain of the contractions, that I'll never forget!). After giving birth, the third stage was easy as it just occurs naturally. Good luck.

Have a look here . It may answer some of your questions. It was a recent thread all about physiological third stages.

Hi lovecloud, I had a non physiological third stage with DD1 (4 hour labour) and borderline haemorraged. I am absolutely certian that the methods employed by the midwives at that time caused or worsened the bleed.

With DD2 (2 hour labour) I opted for a physiological third stage and didn't bleed, at all. Popped the placenta out, (relaxed and of my own accord I hasten to add) stood up and offered the midwives a cup of tea (homebirth, obviously!).

Hello

Thank you for your comments and links. The more I read, the more I am scared!

When I read the positive stories I think well that will probably not be me - not good thinking I know

I really think that my bleed was down to the placenta being tugges and it was absolutely massive. The midwife even commented on this. So if it came out naturally it would have been less bulky and full and probably noty caused such bleeding but then again there is the issue that i pushed hard for two hours so my uterus was probably tired.

I am thinking that this time my labour and pushing will be short so the uterus will not be tired, i would not of used any drugs (fingers crossed) so hopefully reducing the chance of heavy bleeding.

I think maybe in my birth plan i will say natural third stage unless my second stage goes on too long - what do you think?...

the decisions us women have to make! could you imagine men making these? they would faint at the idea

whats a physiological third stage?

delivering your placenta naturally without the help of drugs to speed things up

Message withdrawn

Lovecloud, on my birth plan I had put that I was happy to have a managed 3rd stage (ie. with drugs), but my wonderful midwife told me that if the rest of my labour had gone well, without drugs, then she would suggest a physiological third stage.

I had a waterbirth, with gas and air. I pushed for about 25 minutes. I delivered the placenta in about 10 minutes, squatting in the water bath (which had been emptied) and had no major bleeding at all.

lovecloud i think that may be the way to go!
go for a physiological, but if it gets too long then let them intervene

Oh i never realised you had a choice! They just jabbed me in the leg whilst i was cooing over the new baby lol

Tamba, I only knew about it because I went to NCT classes before dd was born.

Thank you socci and everyone else, you have made me feel more positive about a natural third stage. natural has got to be better right? Unless under certain circumstances. I think I will just play it by ear and aim for a natural third stage unless something comes up.

If labour progesses well naturally, without drugs, then there is no reason not to go for a physiological (drug free) third stafge. If at anu time there are cocerns about bleeding, the injection can be given and the placenta delivered by the midwife. The decision does not need to be made now. HTH.

Hi, I had the same query a while ago & here is the link to my thread. Mears gave me some great info & links to other relevant websites. HTH.

this

lovecloud, I had a physiological third stage with my third baby. This was very much my choice as I had problem with retained placenta after second baby which resulted in a trip to theatre for manual removal under GA - yuk!

I did bleed pretty heavily and after the placenta had been delivered one of the midwives did then give me a shot of synto-whatever it is to help contract the uterus. However, no-one seemed remotely worried about it and the only downside for me was that I had to keep going and having yet another shower when I'd rather have been holding my new baby - but DH and my doula looked after him very well!