OK, being a bit dense, can someone explain the link between blood loss and a physiological thrid stage?

[tassisssss]

Thanks!

Umm probably.....I think what you mean is: can you explain why people are more likely to bleed more with a physiological third stage rather than having syntocin/syntometrine/ergometrine?

Okay, so the baby is out, the next stage is that the placenta detaches from the womb and heads for the exit. This leaves an open wound inside the womb which will heal gradually but obviously because the cervix is open and the womb is big (it had a baby in it just a few minutes ago), there is a lot of space for the blood to flow out.

With the drug route, the uterus is encouraged to clamp down faster (NB it does clamp down naturally especially if you breastfeed but not as fast as with drugs). So less blood can flow out.

There is a school of thought that people bleed more with an intended physiological 3rd stage because there is still too much intereference. The theory goes that nature knows best - there is still some connection between mother and baby even once the cord has ceased to visibly pulse. Blood may still be circulating and so the baby may still be getting some oxygen from the placenta (which means the maternal blood supply to the placenta is still functioning).

If you follow this logic, you shouldn't clamp or cut the cord until the placenta has been expelled, and you definitely shouldn't apply any traction on the cord. The former is quite common in the UK (I think its considered standard for a physiological 3rd stage), and the latter isn't unheard of.

For more info on this have a look here

If you have any kind of intervention (synto, epidural etc) then a physiological 3rd stage is not on the cards as the risk of PPH is increased (your body has already been put under unnatural stress etc). However, for many women a physiological 3rd stage should be the natural outcome in a normal physiological labour. Whilst it is true that studies show a greater blood loss with physiological (and remember this is only estimated) there is disagreement about what this actually means to the woman. There is also debate around whether the blood loss during the first few weeks is greater in those who have a managed 3rd stage and so making the total blood loss similar.
It's also true that as some midwives are not familiar with a phys 3rd stage it can be incorrectly managed so leading to complications.
btw, the placental site is not an open wound, the blood vessels are sealed off by 'living ligatures' immediately. Pph can happen for many reasons, lack of uterine tone, trauma etc. Hope this helps.

thanks everyone

i see my question wasn't terrible clear, I was trying to get my head round whether a physiological third stage meant there would be less lochia in the next few weeks?

Anecdotally (and there are lots of other things this could be down to) i had syntocin with baby no 1 and heaps of blood loss for weeks and weeks, then a physiolgical thrid stage (of sorts, not sure the midwives were v experienced) the second time round and very little bleeding at all. Due again in about 3 weeks and really need to decide what I want!

Starlight, a properly managed third stage is not rare at all, it happens very frequently in Britain. A managed third stage means having the injection and then controlled cord traction to deliver the placenta. There is research to suggest that doing it this way decreases initial blood loss. Anecdotally some do suggest that they seem to bleed less in the weeks after a physiological third stage, but most people who have had both ways have a managed one first time and a physiological one the second & subsequent times. So it could just be that most people bleed less after the second birth. I had two physiological 3rd stages and bled much more with the second (both were properly done) I found lochia to be the same amount after each baby.

Have had managed 3rd stages each time - lochia was greatest/went on the longest with the first and quantity/time has decreased with each subsequent delivery.

Thanks everyone! Thinking i might just have the syntocin and get myself outa there, but this was my one remaining issue as a lot less lochia in the first few weeks would be nice!

(HA, thanks for your email about this, sorry i've not replied before now. you talk a lot of sense.)

i had a natural third stage with ds4, who is 9wks, had him in birth pool and delivered the placenta in the pool too, took less than half an hour, i was a bit peeved that the contractions i had afterwards to deliver placenta were very strong, but it was fine seriously, had the injetion with my other 3 and was always left with a HUGE bruise on my leg from it, really pleased i didnt have it this time

Of course your antenatal midwife could have meant that properly managed physiological third stages are rare, which is true. It is just that the word managed normally goes with the injection and pulling.

Just be aware, sometimes the injection doesn't work. It didn't with me (there is a history of retained placenta in my family). I was then given drugs to basically put me back into labour but after an hour in agony (again!) the placenta still wouldn't budge and so had to go into surgery and lost 3 pints of blood.

Having said that, I didn't have that much lochia afterwards, just as well, I couldn't really afford to lose any more blood!