Retained placenta

[Mysecretumbrella]

I'm preparing for the birth of DC2 and am feeling fairly relaxed about it despite the fact that labour was a pretty horrendous experience with DC1 - I know every birth is different. However the one thing I am concerned about is that last time the placenta didn't come out naturally (even after injection) so the consultant had to manually remove it. It took about an hour for her to pull it all out and thank goodness I'd had an epidural so couldn't feel a thing. But I understand that if I hadn't had the epidural in already then it would be removed with no pain relief and for me this is a terrifying thought - I have a phobia of internal examinations and that sort of thing.

Anyway, what I'd be interested in knowing is whether it's common for the placenta to be retained for the second birth if it was last time? If it seems likely then this will probably impact my decision to have an epidural!

I had a retained placenta the first time (removed under GA because I'd had no pain relief for the birth) but it came out OK the second time, after the injection and a good tug in the right spot from an experienced midwife. I've never heard of a manual removal being performed with no pain relief.

My second one was not retained (but I had no injection, which I did have the first time).

To put your fear at ease - they won't do with without pain relief. First, they should rub and push on your abdomen with traction (gently pulling the cord) while you're having gas and air. If they have to do another manual removal, they can put in an epidural at that time unless you are bleeding a lot, in which case it will be done in theatre under a general anaesthetic (this happened to me during my third birth - the midwives wanted to place an epidural, but the anaesthesiologist looked at the blood loss and said no).

Have had it twice (there is a higher
Chance of it happening again) and if I go for normal birth this time part of my reasoning is to go for epidural as will need it.

And 1st time they gave me epidural for procedure - never heard of it done without .

Thanks. You've all reassured me that they wouldn't do it without pain relief, so that is good news! The midwife I asked about it was possibly a bit clueless. Gigondas, that's interesting that there is a higher chance of it happening again, and I am with you in perhaps wanting an epidural before the birth as I think I'd be rather annoyed to have given birth without one then need one after all! It's also one of the main things putting me off a home birth.

I had no pain relief apart from gas and air and it was bloody painful as the dr seemed to have fingers the size of sausages!

I was told that if he couldn't manually remove it I would be having a spinal block and down to theatre for removal. As it was I was pushing for a 6 hour discharge so was willing to put up with quite a lot!

I had 2 home births, and a few issues with my placenta both times. My DH knew which acupressure points to hold and then the placenta came away easily. It may be worth doing some research before hand just in case.

The manual placenta removal was the single most horrendous event in my life. It is only recently that I realised just how badly it affected me, and even now I get ridiculously upset thinking about it.

I am planning a homebirth because I want to avoid a second retained placenta. They are more likely to occur if you have intervention, and intervention is more likely in hospital. I know they are also more likely if you have had a previous one, but if I can reduce all of the other risk factors then I think I'm giving myself a good shot at it.

I am also going to refuse prophylactic syntometrine (unless I am clearly having another PPH) as you only have 10 minutes to deliver the placenta after the injection has been given, but up to 1 hour before they like to intervene if you try a physiological third stage. From what I can recall from the AIMS book 'Delivering Your Placenta' the 1 hour 'limit' for a physiological third stage is not actually based on any medical need to deliver in that time frame, but is simply what has been set for reasons of convenience.

I had an epidural in place for the labour (induction) and also had a PPH but was still given a spinal anaesthetic for the removal and suturing of the tear I had.

It might be worth shelling out the £8 for a copy of that book (the AIMS 'Delivering Your Placenta' book) - I borrowed a copy and found it rather helpful.

I had a physiological 3rd stage and took nearly an hour to deliver the placenta but maybe just over. My midwives were very relaxed abt it and never rushed me or suggested an injection. It was me that got a little antsy. They did check the cord though.

Flisspaps I can totally understand why it would have been so horrendous. That book sounds interesting, I'm definitely going to try and track it down. Also interesting what a few of you said about a physiological third stage - I'd assumed that having the injection would make it mire likely for the placenta to come out but in fact it sounds like actually it would mean I'd then be given a limited time for this to happen. Need to do have a think about this. One difference this time round is that we're having a Doula, who seems great so far and very experienced, so I will discuss it with her. Thanks everyone.

I had a retained placenta on dd1.

It was a very quick birth and I'd had no pain relief at all. I didn't have the injection, I felt no desire to push the placenta out and the midwife was tugging and pressing on my stomach. I was nursing dd throughout this but it didn't seem to make a difference.

In the end the cord broke away so I was told I would need manual removal.

I was strongly advised to have a general anaesthetic for this and after the doctor helpfully demonstrated the size of his hand I opted for the GA. I obviously have no memory of the procedure and I try not to think about it.

I had an even quicker labour with dd2 and the placenta delivered with no problems at all. I didn't even realise it was out til the midwife said it.

Try not to worry about it but do a little research if you think it would help.

Best of luck.

Guilty, that's a good story to hear! I agree, I don't want to worry about it too much but would prefer to be a bit prepared. I'm going to read up on medically managed vs physiological 3rd stages, and also I think I'll just be clear in advance that if it does happen then I'll insist on an epidural/GA. I've been talking to friends about this over the past couple of days and it seems that the couple of stories I'd heard of people having no pain relief for removal could have been women who actually refused the pain relief. Anyway, here's hoping it will be more straightforward this time!

I knew of a friend's sister who had MROP without pain relief & said it was hideous. I was offered it when I had RP at DS's birth & thought I'd give it a go if there was a chance it could be all over & done with quickly. I had had no pain relief & it must have been too much as I said stop & was promptly taken to theatre for removal under GA.

You cannot have an epidural for MROP unless you already have one in place I believe, altho you may have a spinal. Presumably recovery from epidural or spinal is quicker than GA so would be preferable, but not preferable to no pain relief!

If you have had a previous RP, the safest assumption is that there may be an underlying cause for it therefore you are higher risk of it happening again. How the birth has gone also comes into play, something like 80% of cases are due to uterine atony which is basically overworked uterus so they are more common in first labours, induced/augmented labours, long labours, etc.

The longer placenta expulsion takes the higher the risk of PPH becomes so I guess this is where time limits come from. I also had a 3litre PPH which was grim so would advise that any PPH risk is taken seriously along with RP considerations.

Thanks for that Idlevice. Interesting... my first stage of labour wasn't particularly ling but the pushing bit was, and in the end they used a ventouse to get her out. I suppose it's impossible to know the exact cause of the retained placenta though. Your 3L PPH sounds scary and of course I don't want to increase the risk if that... I was lucky last time in that although I list a lot of blood it was just below the official PPH limit but even that seemed scary. Lots to think about!

The other thing to remember is that you can go for a phys. 3rd stage and IF you have a PPH you can be given the syntometrine at ANY time with no additional risk - so you can refuse the jab immediately, see if the placenta comes away and if you appear to bleed too much you can then have the jab and it won't be any less effective than if you'd had it straight away anyway, but you've given yourself longer to deliver the placenta than you would have had (research into this done by Prof Cecily Begley, Trinity College Dublin)