Natural or managed third stage?

[tiokiko]

Am 35w with DC2 and have confused myself thinking about whether to go for a natural or managed third stage of labour. Obviously if there was a problem or specific concern over PPH I would go for the injection.

With DD I was planning to have the injection but when it came to it the MW thought I could try without it. Placenta came away easily, no problem with bleeding etc so all good.

But now I'm thinking about it again I am confused about what to ask for this time - everything I've read about a natural 3rd stage says that the cord will not be cut until the placenta is delivered, but with DD the cord was cut straight away as it was v short so she was too far away to BF.

What are the disadvantages of having the injection? MW wants to talk about my birth plan tomorrow so just want to get things straight in my head first.

Well you can opt for a natural third stage and have the injection if needed.

If you do have the injection, I think you only have 10 minutes to get the placenta out before the drugs close up the cervix.

I was the same as you with DD but planned natural 3rd stage. When it came to it, the cord was very short so MW advised cutting it straight away and having the injection. Probably a good job too because DD screamed like a wee pissed off thing for 45 minutes before she calmed down enough to feed her. Full marks for irritability on the apgar scale there!

I had a home birth so mW was very relaxed by birth plan and we played it pretty much by ear. Not sure what it would be like in hospital.

I had a homebirth with no.3 and a natural third stage. The placenta came away quite quickly. I'm pretty sure the cord was cut before the placenta was delivered, although I did ask for the cord to stop pulsating before it was cut (more blood gets to the baby if you wait till it stops pulsating, so look into it if you haven't already).

I agree with gallic that you could ask for a natural third stage and see how it goes. That's what I did. If you are low-risk then there shouldn't be a problem with them agreeing.

There are some potential side effects of Syntometrin (the drug they give you to deliver the placenta), including nausea and vomiting, Abdominal pain, Headache, Dizziness, Skin rashes, High blood pressure, Abnormal heart beats, Chest pain, Fall in blood pressure (causing dizziness, lightheadedness, feeling faint), Difficulty in breathing, Shock (blood pressure too low to maintain blood supply to the tissues).

With most things regarding childbirth, i think it is best not to interfere with the natural process unless it is absolutely necessary!

I had no injection both times. First time cord was v short and so MW cut straightaway so that I could get DS up onto my chest and feed him (he only reached my navel!). It took about 20 mins before the placenta was delivered, I wasn't really feeling contractions. In the end the MW gave a gentle tug on the cord and out it came.

Second time cord was much longer so just sat and fed DD. Cord was cut and clamped when it stopped pulsing, but think this was before placenta was delivered.

Both times were HB so MWs relaxed about timing.

Thanks all, very helpful.

Rhinestone - that's exactly the same as happened to me with DD, I remember being a bit confused about where she'd gone until I realised she was right down on my tummy and not going anywhere because of this titchy cord!

You've all reassured me that I hadn't mis-remembered about the cord being cut and still having natural 3rd stage, I thought I might have got this mixed up.

NICE guidelines give you an hour for placenta delivery if it's a natural 3rd stage (I think) so I'm fairly happy about not being pressured on the timing as long as all has gone well and there are no concerns.

I had the same - short cord was cut straight away so I could cuddle my DD - then I BFd her, and delivered the placenta afterwards - think the contractions you get from the hormones caused by BF helps the placenta come out.

I was so involved in having the baby I had actually forgotten about delivering the placenta and the midwives had to remind me, came out with a few pushes and possibly pulls from the midwife.

Am planning the same for next birth, any day now, fingers crossed!

Hi - I second (or third) what the other posters have said, I had a short cord - we waited tll it stopped 'pulsing' for want of a better word, cut and clamped it, then had a natural 3rd stage.

Except I couldn't deliver the placenta as I had about 20 litres of wee inside my bladder, but no senation of needing to go. If you can possibly remember, have a wee (or 2) during labour. As soon as I'd been, it plopped straight out!!

Hi, I've had 3 natural third stages; each time, I had a cuddle while we waited for the cord to stop pulsating and it was cut then I handed the baby to DH while I delivered the placenta. The contractions can be hard to recognize after you deliver (weak and not at all painful) but each time it has popped out within 10 mins (and a few pushes) but there is no pressure to deliver it quickly. MW had the injection on standby just in case. PS: if you deliver in water (in hospital) you have to get out to deliver the placenta natural or otherwise.

I have had a managed 3rd stage (in hospital) and a natural 3rd stage (at home).

First time around they clamped the cord and gave the injection very quickly. I didn't really know much about it at the time and hadn't specified any different. It was quick and easy, although with greater knowledge I'd have preferred for the cord to stop pulsating first.

Homebirth with my 2nd and a natural third stage. I really hated it - by a long way the worst part of the whole process, and the only downside to an otherwise great experience. It took ages to get the placenta out (to the point where I thought I'd have to go to hospital and get it removed) which distracted from time with my new baby. I lost a lot more blood than first time around and could barely stand up for the next 3 days.....had to crawl to the loo etc.

This time I am planning a home birth again. I will ask for the midwives to wait for the cord to stop pulsating, then give me the injection.

Like pootle bug, I didn't like my natural third stage at home. I wanted to wait for the cord to stop pulsating, to allow the bloodflow back into DD. But then I had more than half an hour of "stand up and push" - I'd had enough of pushing by that point. The placenta was apparently "right there", as in, detached and at the cervix, but I didn't seem to be able to get it out under my own steam. After about 40 minutes I asked for the injection, and the midwife pulled on the cord and got the placenta out within 5 minutes.
Next time I will ask for a delayed managed 3rd stage as in, delayed cord clamping, and then the injection when I feel ready for it.

I tried for a natural third stage with DD (following letting the cord stop pulsating while still in the water, then getting out to try and deliver the placenta on a stool while bf-ing) but when after an hour and a quarter nothing had happened they reckoned I was losing too much blood, so advised some intervention.

The first thing they suggested was that I should try and pee, but I couldn't so then they offered to catheterise me to empty my bladder and like a complete idiot, I agreed - I was so set on not having the injection! It was WAY more painful than the delivery!! Anyway, that still didn't work, so then I agree to have the injection, and that didn't work so they tried to put a syntometrine drip in instead, but I have crap veins on the back of my hands and the poor midwife (who'd been wonderful) ripped my vein, so eventually (after an hour and a half post DD being born) they got an obstetrician in who got the placenta out by controlled cord traction.

I have no idea why it all took so long but I wasn't rushed into making a decision, which I thought was good on the hospital's part (it was a birth centre so that's probably why)

Anyway I'm 40 weeks with no 2 so not quite sure what I'm going to do this time... probably go with same plan (minus the catheter part!) and play it by ear.

BF-ing is supposed to stimulate the placenta to come away and (a) being an inexperienced bf-er and (b) it turning out a few weeks later that DD was tongue-tied, it could be that the latch at the beginning wasn't strong enough to stimulate that response.

But one good thing was that I barely bled once I got back home - I was out of the big maternity pads after a couple of days, so maybe all that blood was just womb lining that had to come out anyway! I know a natural third stage is supposed to mean less bleeding after it's all over.

I had no idea how common a short cord is! I too opted for a natural 3rd stage as I wanted DS to get as much of the cord blood back in him as possible but in the end it was cut pretty much immediately as we were in the pool and he only came up to my naval!

Got out and sat on the birth stool but DS refused to suckle at this stage so sat there for what felt like hours (30 mins, absolute tops) with no urge to push what so ever (did have a HUGE wee thought ). Did deliver the placenta naturally but had to push with no urge to which I found odd.

TBH I was only having a natural 3rd stage to get the cord blood back in DS so the numb bum and sore back from perching on the birthing stool seemed a little redundant! That said, would do it naturally again.

No reason to think your cord will be short again.

Really good discussion about 3rd stage stuff on the homebirth website (doesn't matter if you're not planning a HB as it's all still relevant):
www.homebirth.org.uk/thirdstage.htm

This is really interesting, thanks all - I think I've had a rosy view of a natural third stage from DD's birth by the sounds of things.

I don't really remember having to do much full-on pushing at all - I do remember that nothing much seemed to be happening then the MW realised that I still had my TENS machine on and thought that might be delaying things.

I think almost as soon as my TENS came off, I delivered the placenta - weird.

Thanks for the link squiggley - looks useful, will have a proper read later.

I loved the injection personally - Placenta shot out, did not want to push it.

I had a natural 3rd stage and it all very quick and easy ( thank God because labour was loooong) but I am more then open to the injection if things get tough this time. I think I'll ask for natural but with the injection on standby.