Managed or natural third stage?

[Kingsroadie]

Hi - just need a bit of help discussing the options. I am almost 38 weeks and had thought that if I manage to deliver without an epidural I would try a natural third stage as I just figured the body knows what to do naturally surely? And if I start to bleed a lot then they can just give me the injection? But I am slightly worried about retained placenta etc as a result. Don't fancy a manual removal in theatre!

However, am now staring to think that maybe the injection is a good idea as it it now routinely given to everyone and so the benefits must FAR outweigh the risks? Obviously it is a lot quicker than a natural third stage, which isn't really an issue for me but do the midwives prefer it if everything is done and dusted quickly? Also on my maternity notes in the birth plan bit there are questions for you to think about. The phraselogy re syntometrine injection is slightly scaremongerish: "would you like an injection to reduce the risk of heavy bleeding immediately after the birth" which seems a little weighted towards a managed third stage.

Anyone have any pearls of wisdom? I am sure I won't actually care at the time but at the moment I can't mae a decision about what to eat for lunch, let alone this! baby brain...

Thanks!

Managed third stage for my first two in hospital, physiological for dcs 3 and 4, both at home.

Much preferred the latter. Cords not cut until placenta delivered, a very very precious time with dcs where they were still part of me IYSWIM.

Afterpains worse after last two, but was told to expect that as a multip.

This is all a total mystery to me - despite having had a child!! By the time he came to be born it was complete panic stations - three doctors had rushed into the room (one to resussitate the baby I later found out!) so I have no idea what happened to the placenta, who cut the cord, whether I got an injection or anything. All I cared was that my baby was out and healthy. I had a few moments with him before he was taken away for review, so presumably the cord was cut immediately.

The cynic in me reckons m/ws push for managed as it is quicker for bed turn around and some probably do not have much experience of handling a natural one. Apologies to all m/ws for that sweeping generalisation!

I take on board anniemac's point about modern medicine being there for a reason but as Pavlov pointed out, it is not that having the injection is an immediate requirement or no choice to have it. If a natural 3rd stage develops complications the injection can be given at any time.

Thanks everyone so far! I think I am going to stick with what I originally thought, which is try for a natural third stage (birth permitting) and have some sort of time limit (which I imagine a MW would want to impose anyway) for the injection if placenta hasn't delivered. In any event if it comes down to it and I have had enough I am sure I can ask for the injection immediately...

Kings, sounds like a very sensible plan. Iirc the time limit on natural 3rd stage is 60mins but you m/w should be able to confirm. Good Luck.

i asked for natural with my 2nd, mw was amazed but said fine, as long as you realise once you've committed you can't then subsequently have the injection . anyway, i shook as though in shock for 60 mins, and it really hurt, not in regular contractions but in a constant achy judder, and EVENTUALLY the placenta came out after i'd walked around the room, to the loo, etc with dd still attached and being held by the student like an offering in front of me.. not something i'd repeat, but you never know how it's going to happen i guess.

You can subsequently have the injection cos I did. Had managed 3rd stage with ds1, then for ds2 had in my birth plan (homebirth) that I would like a physiological 3rd stage unless bleeding too heavily or I got bored. As it happened after nearly an hour of feeling extremely uncomfortable I asked for the injection and got it. TBH although it was nice to be holding ds2 for that time after the birth I didn't feel anyone was going to whip him off me even if he hadn't been attached - you can always tell them not to. Although maybe in hospital there would be more pressure. For me it was horribly uncomfortable after what had been a good labour. And I still bled for 6 weeks afterwards, just as I did with ds1!

No they don't whip them off you in hospital unless you have loads in the room on ds I had two birth partners my mum and dp and MIL had to come in as soon as ds was born they left me for about an hour and I just wanted bed so they moved me sooner which mw did explain was because I looked overcrowded and she thought I would get bf established easier if I had some peace and quiet.

On dd the mw left me and dp with dd and said when I am ready ask dp to help me in the shower and call her when I am ready to go over the ward we had two hours before I asked to go to bed.