Can you wait for cord to stop pulsating and THEN have a managed 3rd stage?

[basilbrush]

I have read up on the benefits of letting the baby get max oxygenated blood from the cord and delaying the clamping till it has stopped pulsating. This will be my 3rd birth and I thought I would love to do this this time (if all is well, obviously)

So, thinking I was being quite clever, I put in my birth plan that I'd like to let cord pulsate for 20 mins etc , then have the injection to expel the placenta.

But the midwife said that you can't do this and that you either have to have the injection immediately after birth with cord clamping or leave the cord and then push out the placenta yourself an hour or so later.

Is this correct? Can anyone advise me? I want to do what's best for my baby but the thought of more pushing when exhausted/ potential retained placenta does not inspire me!

My main worry is that last time I had the injection, placenta came out very easily but then I still bled incredibly heavily for 7 weeks after birth. The midwives had to strip the bed the first night on the post-natal ward as my blood was running off the sheets and I was going through 10 changes of mattress-like sanitary pads a day for weeks. Unsurprisingly, I became anaemic and could barely walk up stairs without my legs almost giving way!

If that was my bleeding with a managed 3rd stage, would a natural 3rd stage result in even more horrendous bleeding??

It's bollocks: I waited for the cord to stop pulsating, tried for a natural third stage but couldn't do any more pushing, so the MW gave me the injection and the placenta came out fine shortly afterwards.

She is talking out of her bum.

I'm in no way an expert but I'm pretty certain that's not true. I had a natural 3rd stage and was told they'd give it an hour and if there was no action I'd get the injection then. I might have just been lucky but I barely noticed the 3rd stage happening, I was feeding my baby, midwife asked me to give a little push, 2 gross but not sore pushes later it plopped out.

I wasn't able to leave the cord with either birth until it was completely empty as I am rhesus neg and they needed to test the blood. However, they did leave it say 10 minutes and I was comfortable with that. Continued to have a managed 3rd stage with no problems.

I had the same experience as Belmo. Cord pulsated for 20 minutes or so, then had two mild contractions and pushed out the placenta. It wasn't much effort at all compared to pushing the baby out!

I'm resus negative and was able to have the cord left until it stopped pulsating. I then had a managed 3rd stage.

It's bollocks. You can have the injection at any time and it only takes seconds to work- - what does she think happens with women who start with a physiological third stage then have a PPH and need the injection?

I don't think this is right. I wanted the third stage to be natural but after 45 minutes of waiting and nothing happening I asked for the injection. My mw told me they give you an hour before offering the injection.

As others have said it should be fine, with ds2 the cord wasn't clamped, the mw wanted me to have natural 3rd stage but after a bit (not sure how long) it wasn't working so they gave me the injection, placenta delivered and then they cut the cord, was prob about an hour from delivery before they cut the cord.

I was also told no you can't.

I'm pretty sure you can do both. If all else fails ask for the delayed clamping and then after your 20mins or so say you're tired and you'd like the injection now.

My midwife said that she'd been to a lecture where they were in favour of delayed clamping but reckoned that its the first 10 mins that were most beneficial even if it took longer to stop pulsating. I don't know how accurate this is, but I think it means that I'll be fairly happy if I get those first 10 mins even if its followed by a managed 3rd stage.

With my first I had a water birth, the cord was not cut until it stopped pulsating, and I had the injection after I got out of the pool. Must have been a good fifteen minutes after the birth. Placenta took another 20 minutes to come even with the injection but then I pushed it out easily when DP suggested I get up and walk around a bit. No pain at all, just an urge to push.

Second time around I decided not to have the injection but as I stood up to get out of the pool I had a PPH, quickly followed by the placenta, so had the injection to control bleeding.

The actual pushing out of the placenta felt the same both times - I don't know if that helps at all!

Prof Cecily Begley from Trinity College Dublin has done some research indicating there's no additional risk from waiting to see if the injection is needed, and that there may be an issue with the prophylactic use of syntometrine - it is less effective with each use, so if you give it once to a woman who doesn't need it, then if she has it after a second (or subsequent) birth it might work slightly less well.

Have a look here:

here

Flisspaps - that's very interesting!

Yes, this is all very helpful, thank you! I was confused as I was sure it was possible to start off with a natural 3rd stage and then intervene with drugs if necessary. It can't be all or nothing. Maybe they prefer to tell you that so that you just have the injection straight away and they can get on weighing and measuring baby and shooing you into the shower etc (which was what happened with DC2 although I was so euphoric at having managed a VBAC, I didn't care at the time! :) )