Retained placenta - what is it, how to manage it, best options??

[flightattendant]

Hi, just doing some research. It seems (some of) my midwives are concerned about my plan to have a home birth because of the fact I would rather avoid syntometrine...or a 'managed third stage'.

My reasons are to do with my horrid reaction to it last time.

I have no reason to believe my body won't know how to shift a placenta after the baby is born, but I am wondering what the alternatives are should this be the case?

I was told syntocinon can be used instead and is indeed the drug of choice in NZ, Australia etc. but when I mentioned this to the MW she said, 'No, it doesn't cut off the blood supply to the uterus, it just shuts it down - possibly with the placenta still inside'. (Obviously that wouldn't be good)

They seem to be saying that because I don't want the synto, I have no real choice but to go to the high risk unit 'just in case' I bleed after the birth or my physiological third stage doesn't happen by itself.

Is there an answer I can give them? Would it be a true emergency if the placenta didn't deliver quickly? They seem to think it would be a life and death type thing, purely because I don't want the synto? (I think if it were that or side effects, then of course I'd give consent )

Thanks for any input.

i had a pph after having the injection first time and went on to have a physiological third stage with no complications with ds so it certainly is possible.

not medical help i know but thought you'd like to hear a positive story

This site should give you some ammunition!

www.homebirth.org.uk/

Good luck with your homebirth!

i had a retained placenta and believe in can be fatal due to post partum heomarrage (sp). i had the synto injection and it made no difference. as your post says it clamps the uterus down and therefore can trap the placenta. there is a large study (1500 women) i managed to obtain through the lancet online called the hitchingbrook report that gave all the statistics of incidences of retained placenta with and without the syntometrine.
i wouldn't wish retained placenta on anybody and had c-sections for my next 2 births
how far are you from the hospital? why are you high risk?
another thought is that breast feeding can help expel placenta - my ds1 didn't feed straight away

sorry - should be written as hinchingbrooke
see www.altoonafp.org/labor_third_stage.htm
and www.sarahjbuckley.com/articles/leaving-well-alone.htm
i think you now have to pay to view the lancet article but you may find more if you google

Thanks all - just been reading the homebirth site again! It's great isn't it

PinkTulips - thankyou, that is encouraging!

Barking - I'm not really high risk at all, my iron is slightly below their cut off of 10, but apart from that I had a simple birth with DS and have no other contra-indications for home birth.

I think they are trying to cover their backs which I realise is a big deal nowadays...just after some ammo really, the hospital is only about 15 miles away, so in an ambulance wouldn't take too long to reach.

The thing is anything could go wrong and warrant a transfer - not just the general risk that anyone might have a PPH, etc. - on that basis they could rule out anyone having a home birth. I think my reluctance to have the synto as a prophylaxis is scaring them, even though it doesn't preclude retained placenta and even can exacerbate the problem if it DOES get stuck, as the uterus would be too far closed to remove it manually?

(whereas if you wait for it to deliver itself, without having the injection, you haven't closed the highway down iyswim...) Is that right?

there is actually more risk of retained placenta with synto injection , because it starts you cervix closing and your uterus contracting down much more quickly

you are entitled to a home birth, with a phyusiological 3rd stage, which is the logical, natural and pphysiological conclusion to a non medicated home birth

so there!

look at the homebirth site for more info

thankyou for the links Barking - very kind, will go and have a look

Sorry you had such a horrid experience.

Oh! Lulu, thankyou for that, I was wondering if that was the case from what I was reading.

I shall make a stand then! Funny how some midwives like to try and blind you with technical terms... It makes much more sense now.

my lady is meeting resistance to her home birth on very spurious grounds, i will be taking this issue to the next MSLC meeting at the hospital

Lucky she has someone so educated to stand up for her

Do you know about transfer of cord blood etc? On one of those links from Barking, it says the baby should be kept below the uterine level for 3 minutes to utilise this effect to the max. Is this Ok...I would feel weird not holding/feeding the baby straight away?

thanks

don't know about the 3 minute thing, but not having the cord clamped and cut until the cord has stopped pulsating, is a good thing, makes sure the blood goes into the baby.....putting the baby to the breast quickly also helps expel the placenta, so do what feels right at the time...

lulu.... your the childbirth expert. with dd i had a pph and had to be put on drip. i felt very unwell for a couple of days and the PHN noted i had a fever and high pulse when she checked me over.

2 days later i had intense pain for an hour or so and passed a huge chunk of what looked like placenta. it looked like raw liver? is this at all possible? if i had a retained placenta would it just have come out itself like that?

sorry for the hijack flightattendent but i've wondered for 2.5 years and always forget to ask someone who knows about these things

I've had two unmanaged third stages at home. It would have been all three had I not had a rather more managed labour with my first and been in hospital.

I believe that unless you have clotting issues (ie don't clot that well), there is no reason to suggest that you will bleed to death if you placenta doesn't come out in the 10 minutes or so it is "supposed" to take.

Indeed a friend had a home birth with independent midwife, and nearly managed to freak her out when the placenta took 7 (yes, seven!) hours to make its appearance. The placenta carried on working throughout, carrying blood to the baby, and only came out when she stood up to get dressed to go the hospital to have it manually removed.

Pinktulips- I had a piece of retained placenta after my last labour. I had what felt like labour pains about a week after she was born, and out dropped a piece about the size of two 50p coins. Definitely placenta. My daughter's placenta had calcified areas, but areas of new growth all round it, and one of the new bits had dropped off and stayed behind for that week. I did think it strange that I'd stopped bleeding after three days- it must have been plugging the cervix or something; I bled a bit more after that, for about ten days. No complications from it though.

o god, mine was much bigger than that about the size of a good sized steak.

felt immedietly better after it came out, had been really ill and tired til then

PT- did you touch it? Was it firm or more like jelly? My piece of placenta was pinkish rather than dark red. Your thing sounds more like a blood clot to me, and I would hope the midwives would notice a piece that size missing.

I had to have my placenta manually removed after the birth of my dd in January.

It was about 3 hours after giving birth that they took me down to theatre, so IMHO they didn't class it as a true emergency at all, there was certainly no rush. (I had the synto injection, and they still managed to remove the placenta ok)

I've only read the OP so I may be repeating what others have said but here goes -

I wasn't allowed Syntometrin with ds as it caused a blood clot in my retina when I had dd3 which has left me partially sighted. I was allowed syntocinon on its own & was allowed to birth in our midwife unit as was not considered a high risk. I did retain the placenta & the mw gave me an hour to shift it on my own then the plan was to give me a spinal to remove it if necessary.

By the end of the hour I had lost 2.5 LITRES of blood & my womb was contracting constantly in an effort to get rid of the placenta. I have never felt pain like this (and I've had 4 kids mind). I was hooked up to drips & rushed to theatre with 3 people pushing the bed & another 2 running alongside with the drips. By the time they transferred me to the table I was literally praying to die just so the pain would stop. Then some kind soul gave me a general anasthetic so they could remove the placenta manually.

Over the next 12 hours I had 6 units of blood (the first 2 had to go in really quickly so they used a blood warmer & that's used so rarely they weren't even sure how to use it). Poor dh was put into a small side room with ds & he was convinced that someone was going to come in & tell him the worst had happened. I've since been told that it was touch & go & if I'd been a home birth chances are I wouldn't be here now - ds could have lost his mum at just an hour old.

By all means look into all your options, especially if you are desperate for a home birth, but please please think very carefully before you make your decision. In the end what's really important is getting baby out in the safest way for both of you. Best of luck with whatever you choose.

Should add that I've never had problems with blood clotting & I was encouraged to put ds to the breast straight away to try to help things along (I've read the rest of the posts now lol).

I've been warned by the consultant that I shouldn't have any more but I really wasn't planning to anyway - I don't think dh could go thro' all that again!

was solid duchesse but very dark.

that said they showed me my placenta after the birth and it was the same maroon red colour.

the same medical staff stitched up a tear that didn't even need stitching with the wrong type of thread so tbh i'm not completely convinced of their expertise

Greebo - sounds shocking and very frightening. I'm really sorry to hear your story and glad you are alive to tell it.

One thing does occur to me and that is that I've heard that a fourth baby is usually considered high risk, for some reason - my Doula mentioned it though she couldn't remember why. If that's true I suppose it could have had a bearing, but obviously what happened to you could have happened to any one of us and I'm not dismissing it on that count.

Yes, it does very much scare me to think I might be in greater danger with a home birth - mainly of not being transferred quickly enough should something like that occur. I suppose it's something I'll have to really consider.
Thanks so much for sharing your experience with me

PS girls - hijack to your hearts' content!

FA x