Please advice about the Syntometrine injection to deliver placenta.

[mumabee]

Hi,

Please could you help me with deciding about whether to have the syntometrine injection or not.

I am 34+5 and have almost finished writing up the birth plan. The midwife at my antenatal class seemed to push for the injection by implying that people who refuse it are silly and stated that it takes 'a lot of sitting around on buckets' to deliver the placenta naturally when it can be done in 10 minutes, drastically reducing the amount of blood loss. When asked about side effects, she said the only side effect was a sore leg, which I have now discovered is not entirely true.

I am confused, am I putting myself at risk by not having it and delivering the placenta naturally or is it worth having it over and done with quickly?

What did you do? If you had it, did you have any reaction to it? Thank you.

I put in my birth plans that I would not have it unless there was a particular reason to (I wanted delayed cord clamping and natural 3rd stage ideally) - ie very long labour/issues at the birth. You can opt for wait and see - have it after an hour or so if you feel like it or if the MW recommends it for some reason.

For me it was academic as I ended up with EMCS both times

i have had 2 very happy homebirths and with my first i had said on my birth plan that i didn't want synto unless really necessary.
As it turned out i bled an awful lot (enough for it to be classed as a haemorrage it turned out later) and i was given the injection and was very relieved that it was available otherwise i would have been in a sticky situation..
second time around i mentioned this to mw (happily the same one who had delivered dc1) who said that just because i had bled lots before did not mean i would again so i put the same instruction on my birth plan. I didn't bleed much, didn't have the injection but did have to wait an hour for the placenta to arrive which was a bit annoying!
The main thing i was concerned about both times was getting a retained placenta as a result of have the synto - in hospital this would be annoying as you would have to go the theatre but to be carted in after a successful homebirth would have been gutting..so i just wanted to avoid that is possible.
all the best with your decision - and baby!

First birth, textbook labour in birth centre, i had a natural third stage, delivered placenta an hour after birth ish, i was lying on big bean bag cuddling dd (still attached with cord) and attempting at bfing....all very relaxed and nice

Second birth, BBA, baby caught by paramedics in my bathroom doorway (so very hectic) i asked for injection (it had been a 2 hr labour and i was shell shocked) paramedics cut the cord immediately but arent allowed to administer syntocin (except in emergencies possibly a PPh or something) unless MW is present. So i delivered placenta naturally about 5/10 min later when MW was arriving.

I was told by my antenatal teacher that if you have any drugs to help you in labour you cannot deliver the placenta naturally as the natural flow of hormones has been interrupted. Don't know how true this is.
I had the synto injection having had a shot of meptid during labour. I had no side effects but did end up having to sit on a birthing stool to deliver the placenta when it hadn't appeared after 15 mins.

21st Century - we are blessed with all this pharmaceutical research for a reason - embrace it!!

Thank you for your replies.

fairylights does the synto cause a retained placenta? The midwife said that they tug on the cord, pull it out and check it when synto is given. Does it all come out in one piece when delivered naturally? I can't get the vision of a big lump of liver out of my mind. Sorry if this is a dumb question .

i didn't have it. delayed cord clamping for about 20 minutes whilst i snuggled up with DS, then after the cord was cut the midwife asked me to move back to the birthing stool to deliver the placenta - it kind of fell out of me on the way, she had to move very fast to catch it in a bowl it really was as easy as that. it's totally ok to wait & see what happens - i put on my birth plan that i wanted to wait for an hour before being offered the injection & that was fine

mumabee tbh i am sketchy about it all now but i can just clearly remember my doula saying that because the synto basically causes the uterus to contract more quickly than would naturally happen - if the placenta is not on its way out then there is a chance that it is more likely to get retained. I think.. someone else may correct me, sorry!
And yes, it should all come out in one go and its a bad thing if it doesn't - the mw should check it carefully. When my mum had my sister a bit of the placenta was retained and she heamorraged a week later (but was ok in the end!). It does look like a very very large bit of liver i am afraid, pretty gross. Can't quite imagine how some people eat it but i am sure its very good for you!

Syntometrine is not necessary of you have a totally normal delivery - it will, however, reduce your third stage (placenta delivery) from around an hour to around 10 minutes (in most cases)
A retained placenta requires you to get a spinal anaesthetic and then a surgeon peels the placenta manually from your uterus. Personally, I'd have the injection and get it over in 5 minutes........

fairylights - that was my understanding too

I'm natural all the way except this bit, having delivered a baby, waited for the cord to stop pulsating the thought of then waiting for the placenta to be delivered before getting showered and something to eat (I'd imagine nobody will let you eat or drink in case you have to go down to theatre) fills me with horror.
Personally by that point I think I've worked hard enough and want to get onto the fun bit of snuggling the baby.

In my birth plan last time I was like 33kns, wanted cord to stop pulsating before being clamped/cut/getting injection (there was recent evidence at the time that even delaying clamping/cutting the cord for a minute helps the baby get vital iron supplies from Mum's blood). But bloody 2nd midwife managed to wear my DH down when I was way out of it in labour by asking over and over again about whether he was sure I didn't want to have the injection straight away and in the end what she did was clamp the cord, say 'look, it's stopped pulsating' (doh, yes - what a surprise ) and got DH to cut it. As it was, I also had heavy bleeding so I know I wouldn't have been able to wait longer than a minute, but it's the fact that she was arguing against it before then that annoys me.

So it's great to have a midwife on-side but do beware of shift change and a new midwife coming in...

I had 2 textbook biths - but required stitches in both cases (episiotomy and tear respectively.

From my own personal experience I was really very happy to be placenta free, cleaned up and stitched as soon as possible.

I had the injection, never felt a thing and had no side affects. And the lovely feeling of the first bath after deliveries could not come too soon for me. Snuggling my baby whilst still waiting to deliver my placenta just never appealed really.

I gave birth in a birthing centre where the atmosphere was very relaxed. I hadn't got strong feelings either way regarding the jab. Once dd was delivered it was left a few minutes before the cord was cut and I was asked if I wanted the jab. I said that I didn't mind so she said she would give me 10 mins and see if I delivered naturally. I didn't so I had the jab and it came away in minutes.
If I were to have a second baby I think I would like the cutting of the cord to be done after it's stopped pulsing and then have the jab just to speed things up.
There is some suggestion that having the jab can interfere with breastfeeding. Although I did have some issues breastfeeding I can't blame it on the jab!

i had the injection both times
breastfed both dds immediately after birth
no issues

I gave birth in a pool, brought the baby up myself and cuddled her for 30mins, sitting in the warm water whilst sipping tea made by my mum. Then I bf for about 5mins which triggered the contractions for the placenta, and once out we cut the cord.

Was the calmest and most natural thing in the world.

Can anyone explain what the arguments are against having the synto injection? Apart from it not being "natural"? I had it in my first labour - I'm not sure I was even asked about it to be honest, but am wondering about it this time around.

i am really interested in this discussion. am booked for an induction (41+4) next Tuesday and the midwife mentioned this as part of the normal routine.

My NCT teacher mentioned that having Synto rather than delivering the placenta naturally led to a tendency to have longer and heavier lochia following the birth.

since she mentioned that i have been looking for any corroborating evidence and haven't found anything. Does anyone have any experience of this alleged side affect? My midwife said she had never heard of it and i tend to believe her (NCT teacher was a bit of a "free spirit" iykwim).

I would like to know too, doula advised me to wait 40 mins first to see if it came naturally.
But I don't want to go through extra trouble at a time when I'd like to be coo-ing over baby if there arent any real side effects.
Had it twice no problems, placenta came in a few pushes and was over with.

I found this quite useful reading - no idea how accurate it is though

ASFAIK:

Having the jab means that placenta is delivered faster

Less chance of PPH (although this may be arguable)

You are more likely to have retained placenta as it makes your uterus clamp down fast, and the MW will probably physically pull the placenta out by the cord,

You will have to have the jab if you have been on syntocinin drip throughout labour

You can have delayed cord clamping and the jab

Swings and roundabouts really - depends on your preferred ethos: the best interventions that medical science can provide - or lentil weavery natural

FWIW I have in my birth plan that I want a natural 3rd stage (no jab)

i wanted a natural 3rd stage but in the event it was rather unpleasant
i found it very painful and difficult to deliver the placenta and looking back, i would far rather have been cuddling and feeding ds2, who had to be held by someone else for this hour as i was still going through fierce labour pains
we had feeding problems the first week, and i think this contributed tbh
it was quite visceral and unpleasant, i could really have done with a quick clean up and then sat cuddling ds2 instead

I requested not to have it during my labour as I had a normal labour, no interventions, but the second midwife insisted on putting a full syringe next to me while I was trying to deliver DD then tried again and again to get me to have it, until the first midwife told her to back off.

Placenta came out with a tug on next contraction (TBH I wasn't that impressed about the tugging, there was no need really).

This is one of the reasons I am considering a home birth this time. I don't want to have to battle with the midwives so they can do things quickly.

Tugging is absolutely not allowed with a 3rd stage, and yet it is still often done.