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Childbirth

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

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Original poster

Active or Physiological 3rd stage for home birth?

22 replies

Aefeth · 24/09/2013 21:53

Hi Ladies,

I am just finalizing my home birth plans and am trying to figure out what I would like to do for the 3rd stage. I realize that there are different risks associated with both the managed or physiological approach (pph for physiological, retained placenta/headache/nausea with managed), although my understanding is that the risk associated with pph is greater than the risk of a retained placenta in a managed case. Anyway, just wondering what you ladies did and if you are happy with your decision. Any advice appreciated :)

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pooka · 24/09/2013 21:56

I had the injection. I think! Can't really remember. Probably though - I did with previous labours in hospital.

Was fine, am happy, had no complications or subsequent issues. Contracted down really nicely. Apparently!

pebblepots · 24/09/2013 22:00

I left it to happen naturally

duchesse · 24/09/2013 22:04

I had a physiological 3rd stage for both HB. It went fine for me. Whether it is the best option for you very much depends on your obstetric history.

Good luck, whatever you decide to do!

PoopMaster · 24/09/2013 22:14

I had the injection after trying for an hour to do it naturally...I say trying...I wanted the injection straight away but was "encouraged" by the midwives to do it naturally as according to them I'd done the hardest bits all in my own (fair point I suppose).

I was in labour for 15 hours, ended up giving birth with just DH present as things progressed rapidly all of a sudden - so by that point I just wanted to get the delivery/stitches/etc out of the way so I could cuddle the baby and get into a nice warm bath for some down-time

Next time I'd choose homebirth again, but it's going in my notes in block letters - ASSISTED 3RD STAGE

Ezza1 · 24/09/2013 22:18

3rd DC I had physiological 3rd stage ending with retained placenta requiring manual removal in theatre. Would not like to go through that again. Due any day with 4th DC and going with managed this time, same as DCs 1 and 2.

Pascha · 24/09/2013 22:18

I started off doing it without but they were concerned enough by the constant trickle of blood to get me out of the pool and have the injection after 15 minutes. I was happy with that.

Original poster

Aefeth · 24/09/2013 22:18

My obstetric history is completely clear--so I guess it's more of a personal preference issue. I've heard that it can take up to an hour if you do it naturally? My thought was that I would maybe just want the placenta delivery over and done with so I can focus on the fun stuff of getting to know the new baby :) Pebble and Duchesse how long did yours take? It would obviously be great to avoid potential naseau/headache, but it seems that minor discomfort might be work minimizing the risk of pph. Does anyone know what the risk is of having a retained placenta if you have the injection vs pph if you don't have the injection? I'm having a hard time finding solid stats on this....

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Original poster

Aefeth · 24/09/2013 22:20

So interesting Ezza1! I thought the retained placenta was only a risk WITH the injection? I guess I am totally wrong!

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duchesse · 24/09/2013 22:23

About 5-7 mn each time. My babies' placentas seem to appear pretty painlessly and very quickly.

SuffolkLatch · 24/09/2013 22:25

I've had 2 physiological - took 20 mins or so both times I think.

gallicgirl · 24/09/2013 22:27

I was going to wait, let everything happen naturally and feed baby while cord still attached.

In reality I was shattered after a 14 hour labour, 90 minutes of pushing and it turned out the cord was too short to feed while attached.

Midwife checked what I wanted and got a tired "finish it quickly" in return! Can't recall if I had injection or not but I know placenta was out in a couple of minutes with no effort.

Be informed and keep an open mind because you never know how it will go or how you will react.

princesscupcakemummyb · 24/09/2013 22:55

with my other 2 in hospital it was assisted 3rd stage this time im booked for homebirth and midwife wants me to try do the 3rd stage naturally so im happy to try but agreed that if it dont work assisted is fine :)

PurplePoppySeed · 25/09/2013 01:08

I went for natural 3rd stage again because every else was going to be pretty natural.

Mine literally fell out as I got out of the pool, hit the floor still attached to baby! Bit surprising as I was expecting it to take a while too!

As far as I understand, it can be retain either way if your uterus contracts quickly - this can be as a result of the injection or a natural thing - I was told they need to keep you warm for it to be delivered easily.

TheYamiOfYawn · 25/09/2013 01:24

I planned natural with both of mine, for some reason agreed to the injection with DD. I'd waited a while, and nothing was happenning.I was shaky and shivery afterwards, and I wouldn't do it again unles there was a good medical reason.

With DS, the placenta took a while to come out again, but it did come out just fine as I fed DS, and I felt a lot better afterwards.

If you want to wait until the baby has all his or her cord blood, you will need to wait until the cord has stopped pulsing before you have the injection.

WentOnABearHunt · 25/09/2013 11:04

the risk of pph... its difficult to say, a lot of the risk factors for pph are associated with interventions in childbirth, for example induction. if you have a normal physiological birth then you would be a good candidate for a physiological third stage.

A physiological third stage relies on your bodies own Oxytocin hormones and receptors, rather than artificial ones given in the injection. Oxytocin is the hormone of love, and for your body to produce optimal amounts then skin to skin contact for an hour after birth is essential, as is not clamping and cutting the cord. (this has massive massive benefits for your baby also - immediate cord clamping means blood which is the babies is prevented from reaching your baby - which can result in lower iron stores and also cutting off the babies oxygen supply before the transition to breathing oxygen has been fully completed). Breastfeeding also helps as this helps stimulate the production of oxytocin. If you want that bonding time with baby - skin to skin is excellent.... it helps baby to regulate temp, breathing and heart rate. Why the need to rush the delivery of the placenta?

An actively managed third stage... there is still a risk of pph for a start, it doesn't remove it completely. the drug used is called syntometrine, which is a combination of syntocinon and erogometrine. Syntocinon is the synthetic oxytocin and erogometrine also contracts the uterus. it is the ergometrine component which causes the headaches, sickness etc as it can raise the bp. it is also this component which is accosiated with retained placenta as it can cause the cervix to close before the placenta is delivered. there are some recommendations that syntocinon on its own should be used for third stage management... you could request that if you wanted an active management but wanted to avoid the side effects.

its also worth considering that while an active management is associated with a lower blood loss at delivery overall this balances out once the lochia is considered.

If you opt for a physiological stage then this can always be converted to active management if there are any concerns at all. Hope this has helped??

Hawkmoth · 25/09/2013 11:09

I had two physiological third stages at home. I actually got a bit bored waiting but the midwives wanted me to stick to my birthplan.

I'd not actually done much research tbh and with my second homebirth I had a massive retroplacental clot so don't know how the injection would have affected that. Obviously didn't know in advance or I wouldn't have been at home

ChutesTooNarrow · 25/09/2013 11:29

I didn't have the injection. Fed baby, had skin to skin and waited. It was about 55 minutes after birth the placenta came out.

My midwife was not at all supportive though, she was itching to give me the injection. I pushed it out because she was giving me an unhelpful countdown to an hour after birth where 'something' would have to happen if I hadn't delivered it. No idea what because I wasn't having the flipping injection. (Disclaimer, obviously I would have if concerns over blood loss or something or else.)

knittingirl · 25/09/2013 13:32

I had managed third stage with no problems - I didn't notice the injection or the placenta being delivered, I was just cuddling my baby a few mins after birth and the dr said that the placenta was out, and then stitched me up.

StarlightMcKenzie · 25/09/2013 15:08

The evidence isn't clear about pph in physiological stage. It has been argued that it closes the cervix quick preventing the discharged blood from coming out, but it results in heavier postpartum bleeding than if you just let it out at the time of the birth (and have lighter discharge in the next 6 weeks).

But given you can have the injection at any time you may as well at least START with physiological and see how you feel.

Also, the injection doesn't just speed up the placenta delivery but it interferes with the amazing hormone high you get after a natural birth.

StarlightMcKenzie · 25/09/2013 15:10

'so by that point I just wanted to get the delivery/stitches/etc out of the way so I could cuddle the baby'

You weren't allowed to cuddle your baby until the placenta was out?

ChutesTooNarrow · 25/09/2013 15:24

See the not noticing the injection thing bugs me. I had a hospital birth with my first. I was injected but didn't realise. Nobody explained what they were doing, nobody asked my consent. It was just done on autopilot. It was an absolute joy to have my second at home and be completely in control. Anyway I digress...

PoopMaster · 25/09/2013 21:47

Yes I was cuddling the baby for that hour and breastfeeding etc...but with someone sort of standing over you asking you to give gentle pushes, feeling your abdomen and giving the odd tug on the cord it wasn't really my normal definition of "cuddling" iyswim. The process was hurting more than I'd expected and I was sort of "done" with pain by that point (only had 2 paracetamol during the whole 15 hrs, they wouldn't even get me gas and air until I was being stitched up ...probably would've tried harder and been more relaxed with a bit of gas and air).

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