Oxytocin injection for placental delivery

[CoteDAzur]

I found out today that our hospital is undergoing a six month trial where every woman is given an oxytocin injection before delivery of placenta.

I kind of remember that routine injection of oxytocin without even waiting to see if placenta will be delivered on its own is A Bad Thing, but can't remember why.

Can anyone help? I have a meeting with doctor tomorrow and would appreciate some pointers as to how I should argue my case - a scientific way of saying "I'm not your guinea pig and you are not pumping me with hormones for no good reason".

If you have the jab and you have a bit of retained placenta, you are in a worse situation than if you had let nature take its course as the jab causes the cervix to clamp shut, thereby trapping anything left behind. I've had one managed (against my will, was also jabbed despite not giving my consent) ad two physiological third stages. Had the most bleeding with the manage one. Estimated blood after third labour was 100 ml- ie little more than a period. (in fact I've had heavier periods)

btw- pulling on the cord is potentially lethal in itself! Only necessary if patient has been given the jab and birth attendant worried about whole placenta being stuck inside clamped shut cervix.

A friend once had a 7 hour 3 rd stage with her third child, during which tie the cord carried on pulsating. Basically while the baby has not yet started breathing reliably the cord and placenta carry on working.

I could go on. Can you tell I'm rather sold on physiological 3rd stages?

Clement- the student probably wanted you to hold the baby and breastfeed it to help your uterus contract! B/f releases natural oxytocins.

All three of my third stages, whether managed or unmanaged, have taken less than 5 minutes and were unnoticeable in terms of pain or contractions. The physiological ones were the quickest.

I don't understand that duchesse - what would have happened then if the cord had been cut when the baby was delivered?

Why is the cord cutting delayed for a physiological third stage?

N.B. I have recently read a fascinating book about a midwife in the eastend of London in the 1950s and she talks a lot about post-partum haemorages and how they were common until the oxtocin injection

duchesse - Please go on. Three hours until my appointment with doctor.

There just doesn't seem to be enough INFORMATION about this in terms of statistics

I don't see how anyone on their first birth is supposed to make an informed choice about this issue

.... becuase some people are saying 'I'd rather have it naturally!' and others are saying 'NO way, it was awful!' - so how are you supposed to know which category you fall into?

And surely, in this case, all other things notwithstanding, there has to be ONE approach which is the most sensible?

But why would that NOT be the approach that NICE recommends?

I had the injection after instrumental delivery and doctor bloody abseiling off the cord and had to go back in a week later with a womb infection, IV antibiotics and some bloody awful clots coming out....

Not sure I'll have it again when I have DS2 in May/June....

Is it only syntometrine that clamps cervix shut or does oxytocin have this effect as well?

morning paper- east end 1950s- very very poor area with a lot of malnutrition, bomb craters and inadequate housing, overcrowding, disease and people barely out of rationing. Need I say more about risky pregnancy.

Cote D'azur- you may struggle to get the concept around a french doctor! If you've had no previous PPH, you'd have a good case for asking for it. The crucial thing is not to let them cut the baby's cord- that most of the point. Physiological management also evens out the amount of blood in the baby/vs placenta which cutting the minute it comes out does not. The point is that you do not need to cut the cord straight away if you haven't had the ergometrine.

Sorry, have to go out now, but google "physiological third stage" and you should find loads. Alternatively see if one of the MN midwives is about!

ps the placenta keeps working while the baby is not breathing properly. It's a miracle really- nature's safety net.

morningpaper - re "there has to be ONE approach which is the most sensible? But why would that NOT be the approach that NICE recommends?"

What does NICE recommend? I don't know if it's the same thing the French staff at my hospital are doing.

To answer your question, though - Quite often, what is best for the herd differs from what is best for the individual. (I don't know if that is the case here - just trying to gather information)

Take cancer - What is best for individual is to get drugs that will best fight his cancer. However, NICE refuses to fund some of these drugs because they are expensive.

Take routine antibiotic post-episiotomy - What is best for individual is to take antibiotics so as to prevent a potential infection (quite likely, with a cut in an area that is impossible to keep clean). However, this is not best for the herd because routine use of antibiotics makes bacteria stronger.

duchesse & others - When should cord be cut, then?

Cord is often cut when it stops pulsating, as this is taken as an indication that blood flow through it has ceased. Although some women will say a "completely" physiological 3rd stage means you don't cut the cord till after the placenta is delivered if you cut it at all (google "lotus birth" for that one), assuming its long enough to allow the baby to feed whilst still attached.

Sorry about the syntometrine/syntocinon confusion. Had a feeling I was doing something wrong while I was writing it

Thinking about it more, I do think its worth considering what experience of a physiological 3rd stage the MWs in the hospital have - as has been said, it can go very badly wrong if the only difference the MWs make is to not give you the injection.

Let us know how you get on

I find this all a bit FRUSTRATING because it doesn't seem very evidence-based

Syntocinon isn't oxytocin - it's synthetic oxytocin and doesn't necessarily work in the body in the same way. I personally think we fiddle with normal birth at our peril - how do we know all the possible subtle sequelae of injecting a hefty dose of synthetic hormones into women at the moment of birth?

That said Cote, hospital birth is usually managed in such a way as to make pph more of a risk, and therefore a managed third stage makes sense.

And midwives who are unused to dealing with physiological 3rd stages can put mothers at risk by managing them inappropriately.

Morningpaper - IMO it's very difficult to find research which compares outcomes for managed vs physiological third stage in a meaningful way, basically because there are too many variables to take into account re: the labour itself. IMO many normal hospital practices (eg using pethidine which interferes with babies' normal suckling reflex), routine failure to ensure skin to skin contact after birth, liberal use of pain relieving medications and physiologically stupid positions for birth make an unmanaged third stage more problematic.

Morningpaper - there are some studies (abstracts of) this on the homebirth website I linked earlier on in the thread.

Oh, this thread is making me cross.

My stupid mw made me have a pph, which led me being very anaemic. Consequently I found bfing very difficult in the early days and refused to feed on day 5. I heard my baby cry but didn't care, partly because of being so week, but now it turns out that I was also
robbed of my bonding hormone.

My DS spent the first year of his life being ignored and just tolerated. He now has speech delay.

Okay, not 'necessarily' all the midwife's fault, but........

MP I had the jab first time round and puked and puked for hours. I was quite keen to do it naturally with DS2 and had a lovely home water birth so it should have been brilliant, but actually my fanjo hurt and I was shattered and just wanted to go to bed so I asked half heartedly for the injection but it was too late by then. I eventually delivered it into our old washing up bowl. I think placentas are irritating things no matter how you get rid of them.

syntocinon= synethetic oxytocin doesnt contain ergomentrine which is the drug that causes the cervix to clamp shut. Maybe the reason your hopstial is swithing from syntometrine to syntocinon is bevause it wants to reduce the risk of retained placenta?
As somebody saidbefore if you have had a normal labour with no interventions and no high risk of pph there is no reason that you shouldn't have a natural 3rd stage, However the midwives should be experienced in knowing what to look for i.e potential warning signs. (tbh all midwives recieve this information I've already been taught it in my training and I'm a first year!)

this is quite an interesting thread on a midwives' forum.

Also this one is quite interesting anecdotal study about a change in diet and massive increase in PPH among Indonesian women. Scroll down to "Hemorrhage in Asia"

Snowlight - My experience with DD was similar - lost lots of blood, very weak, couldn't care less about DD in the initial weeks.

I thought that was because I was in so much pain that nothing else mattered, but now I think it may also have been because initial bonding was hampered? (No skin-to-skin, baby whisked away to be weighed etc then handed to my mum outside the door )

Cote, it just gets better and better doesn't it?
Will ask DH if he can drum up legal info on patients' rights in Monaco, if you like, so you at least know if you can convincingly wield the suing argument or not.

Did you get the long, rambling and not-of-much-practical-use e-mail I sent you ages ago?