Consultant appt tomorrow re: 2 retained placentas want to be armed with questions as want a physiological third stage help me.

[2beautifulgalsandabean]

I have a consultant appointment, this is my 3rd pregnancy and i am currently 15 weeks.
My 1st two labours and births were natural with just g+a and pethidine, unfortunately i had a retained placenta with both and after all my hard work was taken to thearte given a spinal to remove the placenta manually.
I would really really like a physiological third stage this time as all reading i have done indicates that this can help prevent another retained placenta.
Has anyone been through 2 retained placentas and gone on to delivery a third naturally?
What did you do different;y if anything.
I will be giving birth in a different hospital and trust to last time, due to location of where we now live. Will they have my birth notes from previous 2 times?
I have already been told by my midwife that as soon as i get to hospital a drip will be put up etc incase of it happening again!
I really don't want this, i like to be very active in labour and free. I want to try without the pethidine and do not want the syntocin.
Am i being totally unrealistic and should i just resign myself to the fact that i will have another retained placenta?

I've no personal experience of retained placentas, unfortuantely.

Did you try for a physiological 3rd stage on either of your previous births?

If it were me, though, I'd be asking why they needed to get an IV line in when you're in labour "in case" they need to give you anything afterwards. I'm not trying to trivialise it (and I may well be wrong) but I didn't think a retained placenta was usually a "have to get you into theatre ASAP - everyone grab something and run" style emergency unless there were other complications. In which case they'd have time to site the drip. What do they want to be able to put down it, anyway? I thought synto for a managed 3rd stage was usually intra-muscular? Why do they even need a drip? Surely as long as they've got the canula in attaching the drip would take seconds? If I'm right on all of that then I'd be refusing to allow them to put a drip in on those grounds, and probably refusing to allow a canula as well as at best its going to be annoying. (Not that you need to tell them why, but it might make life easier!)

I'd expect them to have your maternity notes from the previous hospital. If not, I'd be asking for another appointment once they've accessed them. Understanding what was done during your previous two births would seem fairly important to planning this one, and trying to do that with out the notes strikes me as a trifle futile.

If the consultant is adamant its important to get a drip into you before the birth, ask him what research he's basing that on. Make notes. I'd be asking very pointed questions about how restricting my movement and options during the 1st and 2nd stage is likely to reduce the risk of a retained placenta. At the end of the day, they can make recommendations but its your body, your baby, your birth and your decision as to what actually happens. In the words of Mary Cronk, "'Allow' is not a word to use to a mentally competent adult".

(can you tell I'm a nightmare patient yet )

Thanks tangle, what you said makes a lot of sense.
I have just spent the last hour researching and reading through my previous birth notes and know that what i want makes sense.
Didn't have physiological stage with other two and have read that active managed stage can increase the retained placenta occurence.
Will be armed tomorrow with my notes, questions and what I WANT.

Hi I've only retained one placenta then gone on to have a normal delivery, and am now 12 weeks with no 3.

IIRC i did end up having a canula placed with dd2 when I went into labour but it didn't really bother me, it may well be protocol but should not be set in stone. I had a very active labour with dd2 (v different to dd1) and using hypnotherapy cds and tns I managed until the last 20 mins when I had gas and air, I did have the syntocin im injection tho'

HTH and good luck

2beautifulgals
sorry to add a negative experience but I had an attempted physiological third stage (wonderful for bonding ) after an active labour using G&A. I was given intra-muscular syntowhatsit 1hr after dd's birth (1st pregnancy).

Another hr waiting led to a very traumatic attempt at manual removal with me back on g&a after which there was a mad panic rush to get me to theatre before my cervix closed for a manual removal under spinal. The drs really struggled to get a cannula in my hand as my veins had collapsed after the shock & trauma. I have been told that I should have a managed third stage next time .

From what I have read since it is completely random as to whether you will have a retained placenta and that time only becomes critical if you have the injection (due to the risk of cervix closure). I believe homebirth/independent midwives are more flexible on waiting for the placenta to arrive in its own time.

I applied for my medical notes soon after in an attempt to help me recover mentally. Good luck, let us know how you get on tomorrow.

I'm sure you've come across this but just in case - a fairly important part of a physiological 3rd stage is holding your baby and having them suckle, which stimulates the production of oxytocin (?). I've heard of women attempt a physiological 3rd stage but be told they're not allowed to hold the baby until the placenta is out - which, unsuprisingly, it still hadn't done an hour later, new born screaming on other side of room all the time . I've also heard of cord traction being used, resulting in the cord snapping off short and damage being done as the placenta wasn't quite ready to detatch - traction should be used with extreme caution in a physiological 3rd stage.

If you do decide to try a physiological 3rd stage just make sure that both you and your birth partner are fully conversant with the process and are prepared to overide the MW in case she has little experience of this area.

Fingers crossed you meeting tomorrow is productive

Thanks everyone for your input, appt is at 3.45pm.
Tangle the cord snapped last time due to traction, something i would like to avoid this time.
Am preparing myself for a very in depth discussion.