If you have an epidural do you have to have syntometrine?

[nappyaddict]

My friend would like to deliver the placenta naturally without syntometrine. She would like to avoid an epidural but if she needs forceps or whatever then wouldn't rule it out.

She had her epidural topped up for forceps last time but didn't know about delivering the placenta naturally then so would have had syntometrine.

Topping up is different.

If she has not had an epidural prior to the deciding that forceps is necessary she will not get one. She should get a local anasthetic though.

physiological 3rd stage is only recommended in natual labours. So if an epidural has been used then syntometrine will be advised as epidurals can affect the way the uterus contracts and therefore can increase the risk of bleeding.

What about pethidine or G&A?

I had a tiny amount of g&a for dd [dc3] and no syntometrine as I had pre-eclampsia and hideous BP, thus they wouldn't have given it to me anyway. It was horrendous. as was the bleeding afterwards - I looked like several internal organs had fallen out [sbock]

Ditto Me23, anything that interrupts your release of oxytocin makes a physiological 3rd stage unwise, so epidural, episiotomy, forceps, ventouse, pethidine, induction and so on.

I had lots of G&A (and TENS) and was fine with physiological third stage.