Home birth after previous retained placenta

[pavlovthesmugcat]

Can I have one?

I had intended to have a home birth last time round. DD stopped growing properly at about 32 weeks, completely by 38, but knew what mummy needed and came of her own accord just before I was due for induction, but I had to go into hosp for monitoring, luckily I did.

Placenta was retained after birth, removed manually via op. No known cause for either problem were identified (or that I was told about, but I suspect they were related).

I had a retained placenta and a home birth for my next baby would have been disasterous. I had other problems though.

What has your midwife said?

I have not broached it with her yet, I am suspecting its a no too but would like to be armed with al the knowledge I can get before accepting the fate that is destined for me...

Did you ever find out why your placenta was retained?

Well, the stupid midwife pulled the umbilicle (wrong sp) cord and it snapped!

Apparently it is quite common after a section but I have never read that anywhere.

My umbillical cord snapped too as it was pulled (not sure by who or why, but it was not immediately I am sure) They made it sound like it was a medical problem, but perhaps it was their problem then? I never considered the umbilical cord snapping could cause a problem with placenta not coming out?

I had a retained placenta first time. BUT I had 2 risk factors - premature delivery (27wks) and monochorionic twins).

Second time I delivered in a MLU in a major hospital sandwiched between a consultant led unit and theatre.

I was only allowed to deliver there because 1) MLU weren't busy
2) Consultant led unit were over-run
3) MLU was in the same building as a consultant led unit
4) There were known risk factors for previous retained placenta which were not present for second delivery.
5) I didn't heamorrage first time (I retained the placenta for nearly 3hrs before manual removal which I think is unusual)

I suspect that a homebirth will be difficult to campaign for.

As far as I know it is totally up to your local trust/hospital as to what they "allow." Have a chat with them and see what they say?

Oh and 6) I had a sympathetic MW when I arrived for delivery who went and argued with the over-run consultant for me.

Second delivery I had a physiological third stage - so cord snapping is a non issue as no-one should touch the cord. Chances of retained placenta with physiological 3rd stage are lower too.

DoNotAnnoy - I waited a long time before they operated too (not sure how long but about 3 hours, I remember DH saying goodbye to me after being wheeled to the ward at 6:30am, and DD was born at 11:47, so what with the faffing and all, probably about the same time. But that was at my insistence, I had no epidural with the birth and I was keen not to have to have a spinal tap afterwards! Problem with that was it took him 45 mins to get it all out as it was breaking up .

I am sure some-one tugged at the cord? .

What does physiological 3rd stage mean? {blush at ignorance]

I had retained placenta after dc2 (I also think the midwife tugged too hard - the cord didn't snap but I think she messed things up...)

I wasn't allowed to have dc3 in a stand-alone midwife-led unit. I was booked in for a midwife-led unit within a hospital but for various other reasons ended up having a "standard" delivery.

The midwife pulled on the cord with me as she wanted it finished with. Was put in her place when the doctor came in and asked why there was so much blood everywhere.

I wonder whether it is worth just not pursuing it and just accept it will happen.

Maybe it would be better if baby is born in hosp .

Darn, I love the idea of a home birth

For me, a homebirth was never an option with any of my babies and I would always err on the side of caution.

I think you need to get as much info as you can and then make your decision.

My midwife pulled the cord after I delivered Dd3 - I told her to stop. It hurt and having delivered in 40 mins on Gas and Air I needed things to slow down a bit! 5 minutes later I delivered placenta myself.

Loopsy - thank you for that, very informative - i had the 'wait and see' option you described.

I breastfed DD immediately while waiting for the placenta to come out, and once this had happened and she had all her bits done and I had a stitch below, then they attempted to put a needle in my hand and it did not go in, although the woman doing it struggled, so in the end they went in the elbow crease instead.

Sorry Pavlov - I don't understand.

Syntometriene does not normally go in the hand unless it is done as an infusion - it is normally done as a single injection in the arse/thigh. In my case - as it was a twin delivery I had an injection and an infusion (i.e. like a drip bag) as well. It is normal to do twin deliveries as an infusion as there is more placenta to detatch. In my case - though - because I was only 27 weeks I don't think it should have been done as an infusion. I think that I had too much and that contributed to my retained placenta. That is only my own personal (scientific) reasoning though.

Incidently mine came out in pieces too. I initially only had a spinal - but had to be sedated too. I think that is a sign that the placenta just isn't ready to detatch (again personal reasoning).

As others have said -talk to your MW. A MLU at a main hospital may be a compromise if there are such facilities. My MLU birth was fab.

DoNotAnnoy - oh, in that case, I did not have it. I had drugs in my arm, a drip though, I thought it was oxytocin? It was to help the placenta expel is all I know. God you would think I would know more wouldn't you?!!

Unfortunately there is no MLU at our hosp . It is home birth or hospital.

Syntometriene has 2 drugs in. One is Ergometriene the other is syntocinon (which is (or is very similar to) oxytocin. The syntocinon causes contractions to break the placenta away. Ergometrine causes cervix to close I think.

I think you may be able to have one or the other in isolation - not sure though. If it was given in isolation it should have had the ergometrine I think - as syntocinon will (logical head talking here - not anythign medical) surely cause a retained placenta.

Anyway - most women do not notice the injection in teh bum (so you may have had it and not known about it). Also - as I say you can have it i.v. - but i was under the impression that was only for twins (where there is a bigger placenta mass to expell). Although if they thought you had placenta problems or were delayed delivering physiologically maybe there was another medical reason for doing an infusion. Without your notes can't say for sure.

Anyway - talk to MW. You have nothing to lose.

i shall ask my best friend about the injection in bum, she is a nurse and was also present and did not allow them to do a thing to me without me/her/dh knowing what they were doing! She was fab - i will also ask her about the injection, see if she remembers what drug it was.

Will the consultant have the notes? I will be seeing him/her in a couple of weeks.

I will talk to midwife and get pushy see what she says.

Yes consultant will have last times notes.

It will be a good thing to discuss with him what her thought "caused" retained placenta and if he thinks repeat likely, if homebirth an option....as well as MW.

i will speak get pushy with him/her too then!

Hi Pavlov, In a similar postion and same hospital and

I retained with dd1 and didn't want to take the risk of a home birth with dd2, still had the syntometryine, but the placenta came away easily (the first was also removed piece by piece but dd1 was 37 weeks to the day ? early).

The consultant said that although having have 1 retained placenta I was at higher risk it did not mean that it would definitely happen again. I'm 37+5 now and booked in at the hospital near the moor! I have to say last time they were not at all bothered by my previous history ( except i think they may have placed a canula "just in case") Good luck with your research

Oh do you mean Mortonhampstead Community Hosp? Good luck for the pg - you so did not look pg when I last saw you !!

Just as an observation, where and how you birth your baby is YOUR choice - "'allow' is not a word to use to a mentally competent adult" (Mary Cronk). That's not to say that a homebirth is a sensible or safe choice for all women, but it is one that they are legally entitled to make.

If it were me I'd ask a LOT of questions and try to get clear in my own mind what the likelihood was of retaining the placenta again, and what the risks of that in a home environment would be. Once I understood all of that, I'd be in a position to make an informed decision of how the different risks would impact on me and my family.

One thing that strikes me from this thread is that at least a couple of women didn't have a manual removal for 3 hours after the injection - that gives you plenty of time to try a physiological 3rd stage at home, get bored, have the jab (at which point the clock starts ticking), run into problems and transfer into hospital while they get theatre ready (that's assuming you live less than a couple of hours by ambulance away from the hospital)...

If you haven't come across it you might find the www.homebirth.org.uk/ website and the homebirthUK mailgroup informative and supportive.

DonNotAnnoy - I think its the other way round: Syntocinon (synthetic oxytocin) is sometimes given in isolation as that causes the uterus to clamp down and expel the placenta. I thought it was Ergometrine that wasn't given by itself as it would cause the cervix to shut very quickly (minutes) whilst the uterus could take over an hour to expel the placenta without chemical assistance - leading to a retained placenta.

I Tangle is right - TBH teh risks of a second retained placenta are higher after a first - but they are still relatively small.

The problem is that in both cases on this thread the manual removal was hrs after delivery of baby I was under the impression that was unusual. I think that a retained placenta is often associated with primary post - partum heamorage and I think that is the main risk. I have heard (on here) of people being half way down the corridor to theatre when consultant stciks hand up womans fanjo to get placenta out in an emergency.

You might be right - I was speculating a bit. Oxytocin (syntocinon) is used to get the uterous
to clamp down in the event of a PPH after placenta delivery but I thought it could only be used on it's own after placenta had been expelled. I am not a MW though...just speculating so you are probably right.

Oh and I can't remember if I said it eariler - no one should touch the cord unless you have the jab,.