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).

Thinking about it I read it the same way - it was unusual for a retained placenta to be left so long. That said, being unusual isn't the same as being substantially higher risk - I can't see it being advantageous to either the mother, the baby or the hospital to wait around for longer than you need to so presumably most cases get sorted out as soon as its convenient. I'm not saying risks don't increase, but I would ask questions about the data and research that guidelines are based on. Similarly the cases you mention at the other end of the spectrum - without knowing why the consultants felt the need to remove the placenta in the coridor, and what percentage of women wind up needing this treatment, its difficult to draw any conclusions (although the fact they could get their hands into the uterus to do it would suggest the cervix hadn't shut too tightly - I'm getting way out of my depth now, but that does make me wonder if it was more of a race against a cervix closing due to ergometrine. More info needed).

Decisions like this one are never easy, are they? And more to the point there rarely seems to be a one-size-fits-all "right" answer. I think all any of us can do is to try and understand as much as we can about the risks and about how robust the advice is (some is based on research that has since been proven very flawed) and then make the decision that seems most appropriate for us as individuals.

Good luck to PTSC, whatever you decide

It has puzzled me for a long time actually how one can get there arm (up to there elbow seemingly) into a closed cervix 3hrs after the event....

My babies were delivered at 22:05 and 22:20.

I didn't leave the delivery room to be prepped for theatre until at least midnight (they tried for an hour with cord traction etc.) before deciding I needed to go to theatre...then there was the theatre consent....and they got peads in to see me to consent to a clinical investigation.

When I got to theatre we were waiting ages for consultant as they had been called away to an emergency. I think anaesthetist was uttering about spinal begining to fade at one point. It was well past 1am before dr came in.

It was about 3am before I came out of theatre.

I think there are ways of getting through - they can use drugs to relax the cervix (somehow I find that ironic), which will help. Sadly I think they get a fair amount of practice when they need to intervene in a missed miscarriage

DNA - my baby was born at 9.25pm and it wasn't until 1am I got to theatre and had the placenta removed. It bloody hurt.

Before I put in my two penneth have to say sorry not had time to read this whole thread.

I had a retained placenta with my first and wouldn't have had a home birth, was advised to have baby in hospital incase it happened again. Best decision really as although it didn't happen again ds was born with the cord round his neck twice and had to be rushed for oxygen.

The first time I had the injection to help deliver the placenta, but after 1.5 hours I was taken to theatre for a manual removal so in total it took 3 hours to remove.

Second baby I opted for a physiological 3rd stage and delivered the placenta in a matter of minutes hurrah! I asked many mw's over the course of my second pregnancy if they thought the injection could have made it retain and everyone agreed it could have.

If you have a physiological 3rd stage you can still have the injection after an hour if placenta isn't budging. Goodluck with whatever you decide to do.

Pavlov & Doris (PTF waves from Nov thread)- can you give birth at Moretonhampstead?

Have no useful points on the placenta debate, except to say if you are in Devon, the MWs are so pro-HB you should get v helpful info and guidance on this. Good luck.

Nooooooooo the BIGGGGG hospital, was trying to be all discreet like but Derriford.

Pavlov- at the Phoenix I was enormous (or at least I thought I was)

and pootle really sorry but I can't place you, and I'm on due June (I blame pregnancy brain) there is another doris who has appeared on mn tho' (I'm sure I was here first ) but I'm trying not to get tooooo posesive over my Doris status!!!

Hahaha, was thinking MH must have changed a bit!! Was waving at Pavlov but thought you may be the Doris with a slightly diff name on our thread! You are of course welcome to a bit of the wave!!

Cheers I do like a good mn wave- are you Plymouth based too??

I had a loveley home birth after a retained placenta, i would NEVER have a hospital birth ever again. Like others have said, mine was caused by an idiot midwife snapping the cord off, so effectiveley not really a retained placenta but badly mismanaged.
I wonder how often this happens and how they get away with it ?

They actually attempted to remove mine without anesthetic and it was truly barbaric.

I had a loveley midwife from the community team, she did a lot of home births and was very supportive. I declined the injection, and it did take a while for it to come away.Midwife said they wouldve had me in surgery within an hour to remove it which wouldve been unnecessary.

I would agree with what another poster said about the phrase " allow " , we are grown women making informed choices, and more to the point paying for a service.

I would perhaps get in touch with the community midwives and see if there is anyone willing to support you in this. I got a load of earache and the consultant constantly wanted to see me to tell me how dangerous it was.I only saw him once, and afterwards i ws told he had enquired about me and commented that he had never seen a natural third stage.
Says it all really, good luck, and do some research and dont be put off.

This is good to know, frequently - I had a retained placenta with DS. But then I had an induction, epidural, and was mainly on my back. Presumably this wouldn't be the case with a homebirth, so the whole process would be different. It's good to know what's possible - makes me feel more informed when I go and see the midwife for my booking appointment with this one.

"Like others have said, mine was caused by an idiot midwife snapping the cord off, so effectiveley not really a retained placenta but badly mismanaged.
I wonder how often this happens and how they get away with it ?

Snapped cords happen to every midwife at some point. Sometimes cords are quite thin and friable and snap very easily. Usually it's more bad luck than bad management, and I've never met midwife who wasn't utterly mortified by snapping a cord. Still, if it's easier to think of them as idiots...

Re: homebirth after retained placenta. It is interesting that you say dd stopped growing at 32 weeks. That would certainly imply some issues with the placenta anyway, perhaps problems with implantation, which might have impacted on the retention. Hard to say without reading your notes though!

The risk of PPH is fairly small with a placenta that's completely retained (ie hasn't sheared off the uterine wall at all) because there's no 'wound' iyswim. The risk of heavy bleeding rises hugely when the placenta is half-on, half-off the uterine wall, because then you've got a big 'wound' but the uterus can't contract down around it because it's still full of placenta, iyswim! The first scenario would be, as Tangle says, something that you could cope with in a homebirth situation, because you'd have a good chance to get to hospital and get it sorted. The second scenario isn't something I'd want to deal with at home, tbh...

I'll add myself to the list of people who had a snapped cord. It seems from this thread that it may be quite common and perhaps that is a good reason for most people to insist on a physiological (i.e. natural) third stage. I regret giving in when the hospital insisted I cooperated and did things their way! A hamfisted registrar snapped my umbillical cord and then plunged his hand into my uterus and swept around several times to get the placenta out - took quite a few goes as he didn't get it all out in one handful. Unfortunately as I didn't have an epidural I can definitely say it was a lot worse than childbirth. A good reason to be very assertive in any future labour and to write in capital letters in birth plan NO WAY ARE YOU DOING A MANAGED DELIVERY OF THE PLACENTA! I think home births look very attractive now!

I did have a successful homebirth following a hospital delivery that with partial retained placetenta. The consultant also pulled the cord after administering the syntometrine.

With my homebirth, I opted for a physiological third stage but it took ages (more than 2 hours) so the midwife was suggesting the injection. It all worked out in the end though.

I had trouble with a later delivery (late miscarriage of twins) that required a manual removal of the placenta without anesthetic and I would not recommend the procedure.