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Childbirth

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

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Original poster

Managed of physiological third stage?

39 replies

kekouan · 17/10/2007 10:28

I've been getting differing information from various people about this, and I'm having trouble making a decision.

I have no problem with having the injection for a managed third stage, but not until AFTER and the cord has stopped pulsating, is cut and the baby has been handed to me.

Apparently (sorry, I didn't know this) they inject you when the baby is half out, and cut the cord really quickly. I just wanted to delay the injection for a while.

My midwife has told me I can't have this. Either I have the injection immediately, or I have no injection at all. Apparently there is no point having the injection after the cord has stopped pulsating. This doesn't make any sense to me - surely it will still make the uterus contract and assist with the delivery of the placenta.

Can anybody help me/advise on this? I've read up on it, but can't find anything about waiting and having the injection, instead of the usual way of doing things.

The trouble is that she's put 'natural third stage' on my birth plan, which what I asked for.

Thanks very much.

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Original poster

kekouan · 17/10/2007 10:29

which isn't what I asked for. Sorry

OP posts:

Original poster

kekouan · 17/10/2007 10:30

and managed or physiological.

argh.

OP posts:

feb · 17/10/2007 10:33

will be watching this with interest. had natural 3rd stage with ds as wanted cord to stop pulsating and bled a little too much afterwards. not sure what to do when i have another...
x

zubb · 17/10/2007 10:36

I thought you could have the injection at any stage after the birth.
With ds1 I have no idea when I had it. With ds2 it was about 10 minutes after he had been born as thats how long it took the midwife to get there - and she cut the cord first. (he was born on the bathroom floor!). With ds3 I wanted a natural third stage but it was taking nearly as long as the birth so the midwife said she would give it another couple of minutes and then I should have the injection.
So, my experience disagrees with your midwife.

Mij · 17/10/2007 10:42

Beware of MWs who say you 'can't' have things, as it may mean they just don't want to (not always of course).

I did a load of research as I was told I 'wouldn't be allowed' a physiological 3rd stage as I was rhNeg (turned out to be a load of bollocks, and I got my natural 3rd stage, out in 10 mins). I was told that you could have the jab at any time if it was taking 'too long' (which is always subjective, of course..).

Maybe it's worth giving it ten mins after the birth to see if things progress swiftly?

Piffle · 17/10/2007 10:46

I had 2 natural 3rd stages
40 mins eahc time nice and easy

with ds2 my 3rd I had the jab like you describe when he was halfway out and placenta delivered ab fab everythign fine (long stop start overnight labour hence choice to have the jab)

what amazed me is for how long and how much you bleed afterwards with lochia aftr a managed 3rd stage and how little with the natural 3rd stage.

Klaw · 17/10/2007 11:37

I think what you should ask for is a natural, physiological third stage, where you wait for cord to stop pulsating and then with being upright and baby feeding your placenta will probably fall out! If it doesn't you are within your rights to say I've given it enough time, I'd like the injection now please.

Read through this to help you get your head around things.

You CANNOT do it the other way round, ie, have the injection at point of birth and then wait for placenta to arrive. That is a NO NO!

Also if you have had any intervention in labour, ie augmentation by drip you cannot have a physiological 3rd Stage.

Your mw should discuss this fully with you! good luck with your decision and birth.

Original poster

kekouan · 17/10/2007 11:51

Thanks for all the replies... definitely helped. Natural third stage sounds like the best option for me, and I can always ask for the injection if I feel I need it/am too tired to push out the placenta.

Klaw - thanks for the link, very helpful. I don't understand what you mean about doing it the other way round though? (Sorry if I'm being dim)

OP posts:

Loopymumsy · 17/10/2007 13:50

This reply has been deleted

Message withdrawn

Mintpurple · 17/10/2007 17:53

kekouan - your midwife is mistaken in what she says about the injection. Klaw is absolutely spot on (as usual) and you can have the injection anytime.

As for your birth plan - well, its your birth plan so just change it if you want to.

This is the problem with writing something like this in a birth plan, it is so subject to change due to circumstances that you cant forsee. Remember that you are going to be with the m/w for a while in labour so you can always discuss it again at the time.

What I usually do with women who want a natural 3rd stage is as Klaw describes, with the proviso that if there is too much bleeding before or after the placenta delivers, then we will use the injection of syntocinon to end 3rd stage or stop the bleeding. (actually I usually use syntocinon before the placenta has delivered and syntometrine after if there is a lot of bleeding). But what Im getting at is that we talk about it as we go, not just a 'cant be done' type discussion.

HTH

3andnogore · 17/10/2007 18:07

Just a personal experience here....with es I wanted (and did get ) a natural, physiological 3. stage. The Hospital midwife was extremely pushy about the injection and as soon as ds was out sort of told me to push (even though I had no urge, too) and after about 10 or possibly more minutes told me, that that was it, and she was going to get the Injection NOW.
Well, out she went and a minute later I had a massive pushing urge, and out came the placenta....rang the buzzer and she was well pissed off, telling me off for ringing and that she told me she was going to be back soon....well...I had only rang to save her the bother of getting teh injection ready, lol!
With ms I had no such fights, they were pretty good (but different hospital in a different area and years later...so....research might had been changed by then, you never know)....

I think someitmes midwifes are so used to see interventionist Births that they forget it's possibly au natural....

Mij · 17/10/2007 19:36

{I think someitmes midwifes are so used to see interventionist Births that they forget it's possibly au natural....}

Echo that. When I got my natural 3rd stage, bless my midwife's one-to-one cotton socks, she didn't tell me until it was all over that it was her first one! And she had been working as a mw for some years.

stripeymama · 17/10/2007 19:42

When I had dd (now 4) at home, I had physiological third stage that took less than ten minutes.

But its true that midwives can be a bit interventionist - one of mine leant behind me right after dd was born and said in a stage whisper to the other, "Physiological third stages always make me nervous."

Well that's sure to instil confidence in the mother....

suedonim · 17/10/2007 19:51

My mw was thrilled when I wanted a physiological third stage for dd2, as she hadn't done one before.

Klaw · 17/10/2007 19:51

Re the Birth Plan issue that Mintpurple was talkign about: this is why I feel it's much better to refer to it as Birth Preferences, this way the mw, such as the wonderful Mintpurple , know your preferences and can help you to achieve them where possible, and allows for discussion as MP suggests!

3andnogore · 17/10/2007 20:30

sue...with ms m/w's were really good about it all....so, they do exist...
I think, a lot of the time, when m/w's have become very intervention friendly it's not so much due to their own preferences, but because they are so bound to Hospital protocols, it cna't be easy...indeed that is why some m/w's do go out as Independent m/w's...

jamila169 · 18/10/2007 00:19

I think sometimes even when people write a plan, the question, natural or physiological is asked in a way that slams the door on the convo - i.e, not 'would you like to wait, for the placenta to come away on it's own, or have the injection which makes it come away' but rather ' do you want the injection to get your placenta out' If the question is not asked in the right way, then of course women are going to say yes - so then midwives have an endless stream of people coming in with the managed 3rd stage box ticked and like any procedure or task, do it one way for long enough and you get nervous if anyone questions if it can be done differently. it's just human nature i think, unless you're someone who thinks 'squiggly' (as someone once said to me)
lisa x

Loopymumsy · 18/10/2007 06:53

This reply has been deleted

Message withdrawn

jamila169 · 18/10/2007 09:44

Mine says the same Loopy, now if they were being evidence based they'd put ,Do you want an injection after the birth which will hopefully shorten the delivery time of the placenta ,but may also cause your placenta to stay within your uterus, cause heavier bleeding postnatally, give you a terrible headache and rob your baby of blood which many experts feel is vital to protect your child from anaemia? or do you wish to wait for the placenta to separate naturally, with the option of having the injection if there is a problem with bleeding?
Like I said, it's all in the question...
Lisa X

ejt1764 · 18/10/2007 09:54

kekouan, your mw is talking absolute b0ll0cks! Thank goodness for Klaw and mintpurple!

I wanted a physiological 3rd stage, but have had problems with severe bleeding in the past, so discussed it with my midwife, and this is what I wrote on my birth plan ...

? I wish to have a physiological third stage. Please do not inject me with Syntometrine / syntocinon unless there is an obvious bleeding problem.

As it turned out, I did bleed very heavily, didn't pass the placenta on my own, and was on the verge of being classed as having a pph, so opted for the injection, and the placenta was removed with controlled cord traction ... which wasn't pleasant, but at least I had had the option of a physiological 3rd stage in the first place!

PrettyCandles · 18/10/2007 10:02

Complete nonsense.

I, too, wanted any drugs to be given after the cord had been cut. In my first two labours I specified this in my birth plan, and it was adhered to. In my third labour I said that I wanted to try for a natural 3rd stage, but after 20mins I felt so rough (it was more unpleasant than the whole of the preceding labour!) that I asked for the injection and was given it. The midwife said that she had been about to suggest it to me because she felt that I was bleeding too much and was borderline pph.

Each time the placenta was delivered without any problems within the specified 7mins. I think they used cord traction on the first two births, but don't know whether that was because it was necessary or because it was standard practice for that midwife.

MaeWhooooohest · 18/10/2007 10:06

My 'Birth Plan' was full of the words 'I would prefer...', so would agree that Birth Preferences is more appropriate.

I had a physiological third stage (home birth) and it wasn't until afterwards I realised how rare this seems to be. I had said that I wanted to wait until the cord stopped pulsing before cutting it, but in the event DS's cord was v short and he couldn't reach my boob (I am fairly tall). In the event, mw cut the cord so that DS could be delivered onto my chest rather than my belly and then we waited a bit to see what was happening with the placenta. After about 15 mins I wasn't feeling contractions, no urge to push etc so mw asked me whether I wanted the injection. TBH I was so knackered by this point and focussed on DS that I couldn't have cared less. MW then gave a gentle pull on the cord, I squeezed and placenta slithered out. I was v keen to get a look at it for some reason (still off my head on endorphins I think).

So in a long-winded way, as with all things on Birth Plan, best to be flexible and see how things pan out on the day. And your mw is not right that you can't wait and see, because that's exactly what happened in my case.

MaeWhooooohest · 18/10/2007 10:07

Sorry not clear - didn't have the injection in the end, just talked about it.

bealcain · 18/10/2007 10:09

hi,

i had a natural thrid stage. i waited until the cord had stopped pulsating and delievered my placenta almost a minute after this without the cord being cut. Apparently while the cord is pulsating you're still contracting, after that you're no contracting anymore and your placenta will be delivered quickly. Thus you dont need the injection.

Stefka · 18/10/2007 10:23

Where I am they don't even tell you that not having the injection is an option. I only found it from reading about it here.

I have put a natural third stage as a preference if all is going well on my birth plan. I hope it doesn't irritate the midwifes or anything.

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