what are the reasons not to have the placenta expelling injection?

[RobynLou]

I've had 2 VBs and both times had the injection, first time just because, second time I haemmorrhaged so it was needed.
was taking to my friend who's pg with DC3 and doing antenatal yoga. the teacher keeps bringing up this injection and the fact that in her opinion you shouldn't have it.
we did nct together 1st time around and remember something being said about requesting not to have it then.
question is though, why is it considered a 'bad' thing to have? I'm pro natural birth and all, but once the baby was out I wasn't interested in waiting around for the placenta, I wanted it over and done with.
is there anything negative about having the injection other than the view that all intervention is unecessary unless it's vital?

Once you've had the injection you've only got something like 7 minutes (IIRC from NCT class) to birth the placenta before the cervix starts to close so you've got a risk of retaining it and having to have it removed manually.

I had a physiological third stage and found that once I sat on the toilet (with an inco sheet between the seat and the toilet bowl) the placenta came quickly and easily.

SurprisEs you may well not know if you've been given it.

In one of my deliveries, it was given as a matter if routine as baby emerging (standard practice, not what I'd wanted, but as I'd gone in so close to delivery the MW didn't know otherwise and did the usual). I had no idea what so ever that the jab had been given, and had to be told there was no need to it for the placenta. It goes into the thigh, and you simply cannot feel it and probably won't notice - just too much else going on.

I didn't really feel it in another delivery, where I was hoping not to have it, but was asked to as soon as cord was cut as I was bleeding and they weren't sure where from (turned out to be a tear, but I think it was the right recommendation when there is unexplained excess blood).

And I had a physiological third stage in another delivery. I don't remember having to push - it just slipped out all by itself in about 20minutes.

I totally disagree with withwomans comment I am afraid. I have had two very non-medicalised deliveries, but have still needed (and wanted) the injection, as without it I would lose a significant amount of blood. I lose 600mls with the injection.

It's got nowt to do with having easy, 'natural' labours (using the word natural lightly) - and has everything to do with saving some womens' lives.

Apologies - just realised the keyboard made my post hard to read - it should have said "...there was no need to wait for the placenta".

And I agree with peggyblackett PPH can happen to anyone - my friend who had one of her babies a month before one of mine had a lovely natural labour, then needed an 8 pint transfusion. This is not said to scare, but to remind that it can happen to anyone.

And to put the risks of the jab into context, the jab has been given to nearly every woman who has given birth in the developed world for decades, but I don't have any authoritative links on the rate of side effects. There is also no way of telling whether a retained placenta would have come away any better without the jab.

Yes - PPH can happen to any woman after any type of delivery.

Yes - an injection post birth to force uterine contractions can stop bleeding and saves lives.

BUT the number of women who will have an immediate and catastrophic PPH, after a spontaneous unmedicalised birth, where delaying a syntocinon/synotmetrine injection by any time at all after the birth has tragic consequences are very very few. For the vast majority of women who have had a straightforward birth a managed 3rd stage is not immediately necessary, and the decision to move to a managed 3rd stage can be made as and when it appears prudent to do so.

If you want a fully managed 3rd stage - that's fine, its your choice. If you need the drugs due to having a PPH - aren't we lucky to live in a country where they'll be readily available? If you want to take a "wait and see" approach - that's also fine and also your choice and I think there is a lot of information to support the position that this is not a foolhardy or irresponsible decision.

Re. retained placenta - there may be no conclusive evidence, but there does seem to be a general belief that it is more likely to occur after the jab as the ergometrine component forces the cervix to close, limiting the time available for the placenta to detach and be expelled (in my mind it's something like 15 minutes, but PFF may be closer with 7 - either way, not terribly long). With a physiological 3rd stage that time pressure is not there so as long as mum and baby are OK and happy enough, it doesn't matter if it takes 1/2 hour, or an hour - or even longer.

SurprisEs - MWs (or Drs) are meant to receive your informed consent before doing anything to you. So if you were given the jab the MW should have explained what it was and why they wanted to do it, and should have waited for you to agree that you were happy before proceeding. Some HCPs do this better than others...

I didn't have the injection with either of mine, just because I didn't want a drug unless it became necessary, and it didn't. The placenta came out on its own. With my second, it took maybe 30 minutes, but the only effort required from me to get it out was to cough once when the midwife asked me to! I understand that it comes out more quickly if you have the injection - but I was in no hurry, either way I was going to be just sitting there enjoying my baby :)

Cord had to be cut quickly after my DD was born as it was too short and also she was very sleepy. I had the injection, still took an hour to deliver the placenta, pushing was so difficult as I couldn't feel anything to push, placenta finally arrived just in time to avoid me being transferred up to the labour ward and possibly surgery to remove it. Also lost a lot of blood (seem to remember 600 ml?). That was after a lovely calm water birth with no pain relief and MWs basically letting me go with the flow. If I have another I don't know if I'd bother with the injection.