3rd stage - managed or natural?

[insywinsyspider]

I have 2 ds's and both times have had a 'managed' 3rd stage, first time I didn't really see any reason not too, had been pushing for 2.5 hrs and kind of remember thinking 'I've done my job', second time I asked for natural but was advised to have managed as I'd had heavy bleeding in early pregnancy (till 18 wks) but had a low risk second half of preg and a home birth, this time round I'd like to try natural as I'd like the cord to stop pulsating before its cut, dh thinks both times the cord was clamped and cut almost straight away and before it had stopped pulsating.

so first question is can I ask for a managed 3rd stage but AFTER the cord has stopped doing its job or its there a real need to do injection as soon as baby delivered?

dh wants all the facts as he knows I won't be in any position to make decision and, although my mw is lovely, she is suggesting managed so not convinced I'll get a balanced arguement from her

DD (my first) was born at home. I planned a natural 3rd stage, but had agreed with the MWs that they'd have the syntometrine there and ready to use if circumstances indicated it would be a good idea. From talking to them at the time my understanding is that you can have the jab at any point after the birth - even and hour or two later if that's when there seems to be a need for it (ie placenta not come away naturally and/or PPH and/or mother had enough of waiting).

If you do decide to go for a physiological 3rd stage make sure that everone involved is very clear on a few points - like NO-ONE pulls on the cord (it can do a lot of damage to you if they try to pull the placenta out before its detatched, and it will likely take longer to detatch in a physiological 3rd stage than it would with a managed one) and you have skin-to-skin with the baby and start feeding ASAP (suckling stimulates your body to produce oxytocin, which is natures version of the jab - with no oxcytocin you'll be waiting a LONG time for your placenta to come away).

Yes you can have injecton at any point after birth, but you can't do it hte other way round. Cord must be clamped before (or very close to) injection being given.

TBH the placenta normal delivers itself fairly soon after it has stopped pulsating - so if you wait you probably won't need the injection. IME pushing hte placenta out is nothing like pushing the baby. You just have the urge to push and it certainly doesn't require the same effort as delivering a baby.

Finally - you can actually deliver the placenta before cutting the cord - I did and it was fab.

I had a home birth and started off having a physiological third stage, but in the end I had a managed third stage as I got bored after waiting 20 minutes. The cord was clamped after it had stopped pulsating.

Certainly I did not have the injection straight after birth.

thanks, now I just have to speak to my mw and persuade dh - who thinks I should just have a manged one as then its done and dusted, is it just mad preg hormones making me think its nicer to have a natural one? I guess my only reservation - and probably dh's - is that I don't particully bond with my newborn, I didn't want skin-to-skin with ds2, labour was very quick and I can remember feeling I needed 'space' for a few minutes and something to eat before feeding him, I think it really was only a few minutes but I guess if I feel like that again then it would slow down the 3rd stage?

I had a managed one first time after ventouse / forceps delivery. I was then in with an infection a week later with 'retained products'.

I had a natural delivery of the placenta this time and it was great.

I would thoroughly recommend it, though it took a good 15-20mins for the cord to stop pulsing and be clamped.

P.S. Hi Insy!!

Why don't you keep your options open - plan for the physiological 3rd stage and make sure everyone is up to speed on how one should work. Then you can decide on the day if/when you want to have the jab - as the baby's born / 2 minutes later / 2 hours later / never... You could say its like planning a homebirth - you can always transfer to hospital if it feels like the right thing to do, but going back home before the baby's born is nigh on impossible!

I'm no expert, but I wouldn't have thought a couple of minutes delay would have a huge impact - it took about an hour for my placenta to come away so an extra 5 minutes wouldn't have been that big a deal (unless the MWs weren't prepared for the fact a physiological 3rd stage can take more than an hour). But until you're there you don't know how you'll feel this time...

This has been on my mind recently. I had planned a physiological third stage with my dd, but had a managed one after a long second stage and feeling very battered and bruised. I didn't have much joy when I tried researching the benefits of waiting until the cord stops pulsating/blood flowing back to the baby - does anyone have any up-to-date and detailed info/research? This time, the groovy midwives we had were trying to interest me in a physiological third stage (which I was impressed by), but wasn't really in a state to think during strong contractions and said something along the lines of 'Once the baby's out there's no need for the placenta to be loitering around in there and I don't really fancy haemorraging'. (Hope that doesn't offend anyone, but I was in labour!) With both, having not needed any pain relief during labour, I couldn't stand the on-going pain and discomfort afterwards and asked for a localised suppository painkiller, which enabled me to concentrate on the baby rather than how much pain I was in.

Benefits

Baby gets the blood which nature intends (if you think about it neandathal man didn't have syntometrine).
Nobody can take you baby to teh other side of the room cos it is attached to you
If baby is slow to get breathing it is still getting oxygen via placenta
Lochia is not as heavy in the weeks after birth

Personally I was in no discomorft what so ever between delivering baby and placenta. I didn't feel the contractions. There was just an urge to push when it was ready. Not painful at all.

tangle - I think a wait and see is best, dh is worried that I'll say 'oh just do it' and then regret it so he wants to know a definitely answer - typical bloke

perfect - those were the advantages I was thinking about, mostly baby getting everything from the placenta. I'm really not fussed about them taking baby to other side of room tho - like I said skin to skin hasn't really been my thing in past although I do like feeding asap so I guess really its the same thing...

bud _ I don't think what you are saying offends, thats pretty much the reason I had a managed 3rd stage before, once I'd been through labour I wasn't too fussed but I kind of think baby getting all the blood is worth doing since I'm at a limited risk

do keep your options open
i had a natural 3rd stage with ds2 and it was horrible - i hated it and i feel now it contributed to early feeding and bonding problems with ds2 (i was in too much pain to hold him and feed him during that period straight after the birth when they are meant to be receptive)
i would have loved to change my mind but thought that you needed to have the injection straight away or not at all, and the midwives wanted to stick to my birth plan and not influence me to change my mind, so we waited and waited and the ruddy thing came out in the end, but it was NOT a good experience

just an update - had ds3 this am and had a natural 3rd stage, we waited till the cord had stopped pulsating - which I thought was supprisingly quickly! - then asked for injection but by the time MW had got it ready the placenta was delivered for the first time I actually sat and cuddled dc, I didn't do skin to skin or bfeed straight away but I def 'bonded' better with him than others in first half hour - v positive home birth, feeling very chuffed (and probably on a hormone high!)