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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

Benefits of a physiological third stage?

25 replies

SpaghettiBologneighs · 20/02/2013 20:54

Can anyone tell me/point me at info on why a physiological third stage is beneficial? Not referring to delayed cord clamping, as I understand this and will be requesting it again (bar emergencies).

My gut says that interfering with the expulsion of the placenta can't be a great idea, but I haven't really seen much on why. Last time, because I didn't really understand if there were any benefits, and because I was so exhausted I opted to have the injection. I'd like to make a slightly more informed choice this time!

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maxbear · 20/02/2013 20:59

You are less likely to throw up as a side effect of the injection. Your afterpains are also likely to be worse if you have the injection (they are usually worse second time around anyway) I avoided it with all three of mine as everything was normal and my afterpains were not as bad as many people have, for me they were no worse after the second and third than the first.

VivaLeBeaver · 20/02/2013 21:09

Benefits of a physiological stage are less likely to have a retained placenta, less likely to have the sickness, shakes that the injection can give you.

Benefits to having the injection are a lower chance of bleeding and it gets things over and done with quicker. A physiological stage can take over thirty mins and you have to push the placenta out yourself....though its not as hard as pushing a baby out!

Some people argue that the chance of bleeding isn't any higher than with the injection. It's just that you see more of the blood in one go and then have a lighter lochia. Not sure how right this is.

I saw someone have a physiological third stage the other week, estimated her blood loss at 550ml. So higher than normal, but not enough for me to panic about it. However it's classified as a pph, which means in a future pregnancy she wouldn't be allowe in an mmu and would be advised not to have a home birth. Of course it's possible she would have lost the same even with the injection.

LongStory · 20/02/2013 21:15

I dabbled with this one for my four births. In the end I did pretty much every thing else naturally (inc the twins) but after giving birth I was so pooped that I went with the quick option which worked out fine.

Original poster

SpaghettiBologneighs · 20/02/2013 21:17

Thank you both. I'm hoping to have a hb, are the midwives more likely to want me to have the injection? They've been very clear that their appetite for risk is close to zero!

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iwillsleepagainsomeday · 20/02/2013 21:26

I don't understand why one should have the injection if all is fine with the birth. i had my first 2 dc in europe and injection is not contemplated unless for medical reasons. had dc3 in uk and refusef injection (mlu and ok birth). in all three cases placenta came away in I guess something like the first 20/30 min after birth. no pain at all. as for the blood loss i saw in my file that with dc3 I lost 450cc. (extremely quick labour and birth which often results in more bleeding). Have been fine in all three cases.

Would be interesting to understand why they offer this injection only in the uk?

PickleSarnie · 21/02/2013 02:04

I had a homebirth and they didn't even ask if I wanted the injection. I only remembered about the placenta 30 mins later when they asked me to squat and the placenta literally fell out.

Flossbert · 21/02/2013 02:39

Are you planning on having a pool birth at home? I was told I couldn't have the injection if I delivered in the water - something to do with clamping the cord, which may be what you referred to in your OP.

Original poster

SpaghettiBologneighs · 21/02/2013 11:39

Floss, yes, I'm hoping to give birth in the pool. Do you mean you were told you couldn't have the injection if you delivered the baby in the pool, or the placenta? No one has mentioned anything to me about either...

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LeBFG · 21/02/2013 12:40

From what I understand (very little) the OB said to me you have to have the injection right before birth or not at all. If so, then it would be difficult/impossible? to have the injection whilst simultaneously birthing in the pool.

I'm not sure I understand....injection = less risk of retained placenta; natural = more bleeding? I thought the retained placenta caused pph?!? Not sure at all now. Can someone explain?

5madthings · 21/02/2013 12:46

Yiu can have the injection at any point after you give birth it doesnt have to be straight away. You can have it in the pool but you would need to stand up so they can get to your thigh i guess?

I has a pool birth for ds4 and delivered the placenta naturally in the pool and they clamped and cut the cord with me still.in the pool once the cord had stopped pulsating.

LeBFG · 21/02/2013 13:19

OK - my OB was adament that you had to have the injection before baby is born - perhaps there is less benefit to having a later injection (she did say some other weird things too so I don't entirely trust what she said)?

Also, do you have to have natural 3rd stage to be able to delay clamping? I'm really quite dim about this part of labour.

Flossbert · 21/02/2013 13:20

I was told that if I wanted to have the injection I would have to be out of the pool to receive it. I think the reason for this was not so much about having access to my thigh to be able to inject, but something to do with having to clamp the cord straight away, but my memory is a little hazy on the details!
As I delivered the baby in the pool and was in no rush to get out I had a physiological third stage. In the event, I was out of the pool by the time the placenta arrived.

5madthings · 21/02/2013 13:30

If you.have the injection they like to clamp the cord sooner. They can clamp and cut in the pool etc, its just slightly trickiet.

And no the injection.can be done at anytime, its routinely donr as the shoulders are delivered as then you dont noticr it but you dont need to have it then. waiting a few mins orlonger doesnt make a differenve. You can opt for a natural third stage and then if you feel.its taking toi long or there are concerns about blood loss you can have the injection at any point.

LeBFG · 21/02/2013 13:45

I'm so annoyed - the OB just completely lied to me! I had it written into my birth plan for a natural 3rd stage but if nothing happening after 30mins I would like the injection. She contested this point. I said 'yeah, but...' but then she replied by insisting on the timing and then also making a big deal about retained placenta. My private MW says retained placentas are extremely rare and nothing really to worry about so she wants me to have a completely natural 3rd stage. Glad I read this thread!

5madthings · 21/02/2013 13:49

Some health professionals dont like deviating from what they know and do!!

My midwife said i could have it at any time. If you have complications or the drip to make labour progress etc they then want you to have the injection but with a normal labour its fine not to have it or to wait and see if you need it.

VivaLeBeaver · 21/02/2013 19:36

You can still have delayed clamping if you have the injection. There was some research saying this want good practice at the injection may cause an extra shunt of blood to the baby which may increase the risk of jaundice. This has since been disproven.

A retained placenta does increase your risk of having a pph, but a retained placenta is still quite rare. But you can have a pph for other reasons, the most common of which is uterine atony. The injection reduces the chance of an atomic uterus.

You can have the injection at any time. If someone was having a physiological third stage and started to bleed I would give them the injection....obviously with consent. However it will be less effective to give it to someone who has already started to bleed than giving it to someone as a preventative measure. But that's not to say it won't work, it will do but might take a bit longer and might need a second injection and other drugs if bleeding v bad.

Original poster

SpaghettiBologneighs · 21/02/2013 21:01

Atomic uterus :o

Out of interest, Viva, would you opt for the injection personally? Thank you by the way, your comments are very helpful.

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VivaLeBeaver · 21/02/2013 21:12

Ha ha, didn't notice my ipad auto correct. I quite like the idea of an atomic uterus.

Personally yes I'd have the injection. Most people it doesn't make them feel sick, etc. gets the whole thing over and done with quicker and reduces the chance of bleeding.

Original poster

SpaghettiBologneighs · 21/02/2013 21:26

It would certainly shorten labour!

Hmm. I think I will leave, 'please ask me about the injection' on my birth plan and decide when I get there depending on how tired I am.

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Original poster

SpaghettiBologneighs · 21/02/2013 21:26

Errant comma there.

OP posts:

messagetoyourudy · 21/02/2013 21:45

As I understood it you don't have to decide about the injection until the baby is born.
Speaking as some-one who really hates needles and didn't want the injection because of this fear, I actually had the injection both times!

First time because I had a prolonged 2nd stage which resulted in my home birth ending up in hospital so I thought, I'm knackered let's have the G&A and get it all over with. The 2nd time was the opposite- it was SO very quick (45 min from start to finish) I was kind of crazy/delerious and felt the quicker it all was the quicker I'd get home.

I don't feel it had any adverse effect on me feeling sick etc. and having spoken to others who did opt to push it out I'm glad I did.

5madthings · 21/02/2013 22:01

I found delivering without the injection fine, not much different to when I had the injection tbh.

messagetoyourudy my ds4 is called rudi but slept with an I. Love your name!

LeBFG · 22/02/2013 06:22

Thanks Beaver. If the reasons to have the injection so good, why would one choose not to have it? (for the record, I had it last time and didn't feel sick).

openerofjars · 22/02/2013 06:49

I tried an tried to push the placenta out but gave up after over an hour and had the injection as I was knackered! The midwife did apologise in case the injection stung a bit but seeing as I had just gone through the pain barrier pushing a baby out, I didn't even blink. .

I had a home water birth as well and the midwives were more than happy to try natural third stage first.

enjay0811 · 22/02/2013 09:29

Some really interesting points on here and questions I have also! Had injection with both dd's in mlu, 1st was a water birth with dd b2b. I was so knackered, I cldnt have cared less and jst said yes to the injection then got out the pool to deliver the placenta so it was over and done with! 2nd dd jst said yes cos I didn't really know any different and made me v. Sick - projectile all over the room afterpains were nearly as bad as contractions too! Considering a HB this time with natural 3rd stage.

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