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.

Now, this is just one of the typical Mumsnet threads that I read, and find myself thinking 'I really don't belong here...'

I am a fairly educated person, so are most of my peers who have had children, and between us all, not one of us has ever queried whether to have this injection or not. We just all had it. Surely you just want the placenta out as quick as possible, so that you can get on with cuddling your new baby and get shut of the midwives? Why would you actively choose to delay it? I'm not trying to be awkward here, but I really don't get it. Can someone please explain.

I didn't write anything at all on my birth plan - I was a first time mum, I'd never given birth before, and to be frank, I was happy to leave it all in the hands of the professionals. As it goes, it all went fine and it was a fairly standard hospital birth. I would do the same next time round too. I don't see birth as some empowering, well-thought-out experience, I see it as a means to an end to get the baby out safely, no matter how. Am I in the minority here?

Because some of us feel strongly about having chemicals pumped into our bodies unnecessarily. I don't doubt that the injection can be life saving in some cases, but some of us have done research and found that if all else goes well, no interventions and if there is no obvious problem there is no need for the injection. I still got to cuddle my baby while I was waiting, it really wasn't an issue.

Besides I hate needles and hate injections, and in fact feeling like the midwife wasn't listening to my opinion was pretty stressful while I was trying to give birth, so it really wasn't in my best interest either way to try and force it upon me.

I have on my birth plan -

"I hope for a natural third stage so please don't immediately clamp the cord, but if its taking too long or I am uncomfortable I'll ask for the injection"

I can decide on the day depending on how I feel.

here is a fairly balanced look at the pros and cons of managed and physiological 3rd stages

sorry, that was in answer to stressheaderic

there are always pros and cons to every medical procedure during birth
you don't have to read up on it and make choices if you don't want to - but it seems like you are saying those that have, are a bit weird?

Because giving the injection means very premature cutting of the cord. It means adding chemicals that could very likely interfere with the natural hormones in the mother that support bonding and breastfeeding, but the main one for me is that it increases the risk of retained placenta.

The injection was introduced simply to speed up the 3rd stage, not for any medical reason, so why on EARTH would a women consent to it unless she was planning on delivering her baby hauling up her knickers and walking off there and then?

I think you will find that the injection was not introduced just to speed things up but rather to reduce blood loss, not just huge haemorrhages but also to reduce normal amounts a bit further so that haemoglobin levels are not depleted more than necessary

No, that was the reason given after it was introduced to speed up the last stage.

And research now shows that it isn't actually true, it simply delays the bleeding and results in a woman bleeding for longer.

I had it with dd (against my will... i had forgotten to say it pre birth and was distracted watching dd be resussitated when they jabbed me)... I had a PPH and a small chunk of retained placenta (which luckily passed itself 2 days later but did make me quite ill)

With both my boys i had a physiological third stage and it was lovely.

The mws just pottered about doing the regualar post baby clean up and let me have my tea and toast and bf the baby. With ds1 they cut the cord once it stopped pulsing and did all the weighing and measuring but with ds2 he was attached til the placenta came out.

I never realy had third stage contractions, i just shoved it out once the mws judged it was close to the exit (i think they could see it but i didn't really want to know the details!).

With both boys i was up and walking about minutes after the placenta came out... a far cry from stuck to the bed attached to a drip like after dd!

SPF.... my lochia with dd was definitely far longer and heavier than after either of the boys

To Stressheadric - I don't think I would have included anything on my birth plan re injection, but for the article on the BBC website earlier in the month that I gave birth which said the baby benefits from the additional iron supplies it received from the continued transfusion of blood from the cord after birth. I then decided to ask for delayed cord clamping - and would have been OK with getting the injection later, rather than immediately as is standard practice (not that I had the choice in the end...).

Dr Andrew Weeks, author of the article in the BMJ, noted that both the World Health Organisation and the International Federation of Gynecology and Obstetrics (FIGO) have dropped the practice from their guidelines.

Interestingly, the NHS also reviewed his article and suggested a review of practice would be advisable, not that they were making a judgment either way on the article but to acknowledge an assessment of the reasons for current practice is needed. So just because the injection IS standard and given straight away, doesn't mean the situation can't be improved by delaying it a bit...

BBC item
BMJ article
NHS article

I had it after a perfect homebirth. Nobody told me about the risk of a retained placenta - it was just 'OK, we'll just give you this, save time delivering the placenta, la la la...'. I had a retained placenta with no fuirther contractions and the midwife panicked a bit when nothing happened, fiddled around so much that she managed to snap the cord inside me, insisted on catheterising me when I knew damn well that my bladder was empty and ended up dialling 999 and telling me to prepare to be blue-lighted in and have the placenta surgically removed else I'd bleed to death. Thankfully some instinct cut through the panic and told me to just push, and the placenta arrived at the same time as the paramedics. No way would I have synto again though - it ruined what should have been my first hour with my son because he and dh were bundled into the next room after about thirty seconds on the breast.

I had it twice, the second time through iv (in France), both times placenta was delivered fast and with no complications/ bleeding.
I think that the possible side effects from it are less likely/scary than the hemorrhage that can be life-threatening.

But there is no evidence that it stops haemoraging! Whilst there is plenty of evidence that it can cause retained placenta.

I have had a good read through the articles and feel better informed now. Perhaps if I had seen some of them, or known anything about it prior to birth, I may have given it some thought.
The decisions over 3rd stage were never discussed or made clear at any antenatal class. I do now vaguely recall the midwife asking me if I wanted it, during early labour, but if I understand correctly, I had to have it anyway as I'd had syntocin via IV for an hour to bring my contractions on.

I'm not too concerned about putting chemicals in my body, but having a retained placenta is something I wouldn't have liked at all.

I had planned for natural third stage and waiting til cord had stopped pulsating etc. Then after a long labour on gas and air and an assisted delivery (ventouse) i decided to have the injection. A few mins later there was no sign of the placenta and then the cord snapped. So, ended up in theatre for hour and a half with a spinal block for a manual removal, and also lost about 3pts of blood. so, mixed views on it really!

My midwife mentioned a natural third stage at my last appointment, so I had intended to do a bit of research, thanks for the excellent articles posted here I have now decided to opt for it!

We are planning a home water birth, I had the injection with DS1 & DS2 and to be honest it was more of a, "right I will just give you the jab to deliver the placenta", with fundal pressure and tugging which I recall being a very odd and unnatural feeling!

As well as the retained placenta issue, the benefits for allowing the cord to stop pulsating are quite compelling.

I had issues with both my sons being whisked away by unknown staff (brought in after delivery)after a short time for the "weighing,prodding etc", and with my first the auxillary actually dressed him and I remember feeling quite anxious that a stranger was handling my newborn!

When really there should have been no rush, both were straight forward deliveries, no tears or any interventions it just felt like their process for speeding up our departure!

So I quite like the idea that I will be able to snuggle with DC3 (due in 4 weeks) while I deliver the placenta naturally, without having to watch like a spectator while everyone else gets to enjoy my baby!

I feel so much more informed, and my DH agrees. We are def not lentil weavers and have no illusions over the actual practicalities, obviously taking advice from the midwife on the day.

But for us, right now and given the circumstances it feels like the right choice for us!

Good luck to everyone! x

you should definately have it, it shrinks the uterus down very quickly causing the blood vessels to contract and stop any bleeding. IMO can't see any good reason not to.

it can increase the risk of a retained placenta, so that is a reason right there

if you have had a drug free birth then the natural/normal continuation of that is a physioligical 3rd stage, there is no tearing hurry to get teh placenta out

putting the baby to the breast will release the right hormones to expel the placenta and sometimes if it is taking a while, standing or squatting can help

you can alwys request the cord is not clamped and cut until pulsation has stopped

Hmm, I am in 2 minds about this, good to read all your stories and thanks for the links. Have had managed third stage for both my previous births, but still had a PPH with the first. Now i am planning a home birth for dc3 and the increased risk of retained placenta is not something i am keen on, but MW advises me to have it because of the PPH.

And also, both my boys have had quite a bit of jaundice, so would delayed cord clamping increase the risk of that? Readmission for photo-therapy and forced formula top-ups is not an experience i want to repeat, it was awful.

oh, have just read the homebirth link, and a meta-analysis has shown:

'that there was no increase in the incidence of clinical jaundice or need for phototherapy with 'late' cord clamping, although there was some increase in neonoatal polycythaemia.'

so i think i am going to ask for delayed cord clamping but have syntometrin as it does decrease PPH according to WHO and Cochrane review.

My experiences: one synto, two natural would go for the natural again no doubts.

With DD1 was given synto after a fast natural birth, no placenta, had a second degree tear and was in a lot of pain, MW tugged on cord, inserted a catheter, got me off bed and dripping over a bed pan, tugged some more then we were at 55 mins (apparently they have an hour to get it out before surgery), got on the phone to book the theatre, thought she would give it one more tug and luckily it came out. Completely ruined that precious first hour as I couldn't hold the baby much.

DD2 homebirth, baby delivered, cord was not cut immediately, she had her first BF still attached to me, cut cord, placenta popped out after about 20 mins.

DD3 homebirth, same as DD2 but this time I was still having contractions after she was born so begged them to cut the cord after about 10 mins as I couldn't hold her , placenta was delivered in about 20 mins as well.

I am probably going to be induced this time at term for SPD and hope to avoid the drip so I don't need the synto.