Talk to me about the pros and cons of an active 3rd stage

[BettyButterknife]

Had a consultant appointment this afternoon to discuss the implications of my fibroid for my second pregnancy. Consultant's decided I'm lower risk than she thought during my first pregnancy, so no routine growth scans or appointments unless anything changes.

I asked her about my labour last time, as I was surprised to have a canula fitted whilst having contractions and didn't really understand what was going on, and whether I'd have to have the same again this time.

She looked back through my notes and said that although I'd had a canula fitted it was precautionary, and that I had a physiological 3rd stage, with Synto only administered via drip after the placenta was delivered naturally, and administered as a result of heavy blood loss (300ml).

This time, however, she's said I don't need the canula or the Synto, because she's advising me/midwife team to go for an active/managed stage 3, with the injection in my leg as soon as the baby's born. I asked about leaving a window of opportunity for the placenta to come out naturally (it was within 5 minutes and one push last time) but she said they'd rather eliminate the possibility of bleeding as soon as they could.

Anyway, as she also said that it's my choice, I wanted to find out the pros and cons (mainly what cons there may be) of the injection as the baby's born, clamping the cord before it's stopped pulsating etc. Thanks

Sorry, I don't really know enough to talk about pros and cons but I do wonder how they know that you lost 300ml. I mean, is it just someone's rough estimate? Anyway, it doesn't sound like a very heavy loss to me.

I had the synto injection and still lost 300ml so don't see how it's a guarantee that you won't.

Sorry I don't know the pros and cons either. I just knew I wanted it over with asap so that I could get on with holding my baby. The cord was cut after it stopped pulsating though and then I had the injection immediately after that.

Can I ask why you had the drip last time?
Were you being induced?
A fibroid does not usually effect birth unless its very large, have been at births of a couple of women with fibroids that were entirely normal (and treated as such).
300mls of blood loss is not particuirly heavy (500mls or over is counted as a post partum haemorrage) so this should not put you in a high risk category.
There is some good info on physiological third stage here-
www.homebirth.org.uk/thirdstage.htm
I see it as appropriate in a low risk birth which is without intervention (no induction, augmentation or strong pain relief like diamorphine, pethidine or epidural) baby a gentler introduction to breathing as baby continues to get oxygenated blood through the cord for a few minutes after birth.
Active management eans babies get a third of the blood volume they would naturally have in their bodies. Active management can make women feel nauseous and shaky after the birth and some research shows it could negatively effect breastfeeding.
Selina
It allows the

Hi Selina, thanks for your reply.

They put the drip up while I was in labour because they were concerned my fibroid (which grew to 17cm but is on the outside of the womb) might prevent the uterus from contracting down quickly enough. They only switched on the drip after the placenta had come out and the bleeding was noted, which was about 5 minutes after my son was born. I didn't have the injection that time for the very reasons you put in your post - I wanted my son's cord to stop pulsating before it was clamped as I'd read it was now considered to be the best course of action for baby.

I'm reluctant to go with the advice of the consultant as I feel it's a precaution against possible heavy blood loss which could be managed as and when it happens, like in my first delivery.

But equally I don't want to put me or the baby at risk, which is why I want to get all the facts at this stage.