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.

Can anyone elaborate on the effect having the injection has on retaining the placenta?

Had the injection both times- didn't even give it a 2nd thought.

dd1 all was fine placenta came out without me really noticing.

dd2- had retained placenta, pph, spinal block for placenta removed in theatre, 5 days in hospital, blood transfusion. Missed her first feed, cuddle, clothes, kept getting her name wrong all pretty horrendous.

Now 24 wks with dc3 and have seen a consultant to discuss. When I asked about the injection she said yes I would definitely have to have it but would be put on a drip immediately after birth to keep the contractions going.

While I don't want the drip really I most definitely don't want to go through same again as with dd2. Her birth was less than 3 hours all good only to have all that afterwards..

So what does everyone reckon? does this sound right?

For some reason obstetricians have an obsession with synotocin and vitimin k.... they seem to become very upset if both mother and baby haven't been jabbed with a needle within minutes of birth

When i was being cleared for early discharge with ds2 the doctor's biggest concern was that i hadn't had 'the medicine' and 'could bleed to death' (honest to god i'm quoting his exact words there)

Despite me pointing out that it's not medicine it's an artificial hormone designed to contract the uterus and expell the placenta and that i'd given birth to the placenta just fine and my uterus was contracting very well and i'd be sure to let someone know if i suddenly started gushing blood he was still very upset about it all

i had it with my first (hospital) birth, no problems other than it made me really sick, so i had to pass my ds to dh while i was puking and missed out on 10 mins or so of that first skin to skin cuddle with baby . and like others have said, cord was clamped the instant ds born - placenta tugged out all seemed hurried and not necessary after a complety normal birth.

with my second i had a homebirth and requested not to have it unless there was a real reason - such as a bleed. we delayed cord clamping until pulsing stopped,placenta delivered easily within a few mins all while i was BF dd. and no sickness this time.

girls You don#t 'have' to have it. That is complete rubbish. Ask for the medical reasons and then research them to assess your own personal risk and remember that there are risks to both having it and not having it.

In general, if you have had any other chemicals in your body baring gas and air, or pethedine close to the birth then your body's natural ability to figure it out will be impaired so it is probably sensible to have it.

The research seems shows that there is a certain amount of blood to be lost post birth. The injection can reduce the amount that comes out in hospital but prolong the lochia at home. Not having the injection can do the reverse, so yes, there is more bloodloss there and then but overall not.

You do have to make sure that the mw knows what she is doing though because a lot of them do tug the cord with a natural third stage, and ripping your placenta from you before your uterus has contracted to release it is a sure fire way of making you bleed lots, - so absolutely NO tugging.

I had a pph with my first WITH the injection (and a mismanaged birth) but lost so little blood 2nd time round with natural the midwife said she couldn't just put 'no blood loss' so put 150ml.

Sorry, to answer your question, the injection has two functions.

1. to contract the uterus to release the placenta

2. to close the cervix

The risk is that no.2 happens before no.1. This risk is not there for a natural 3rd stage although it is often argued that with everything going slower there is more time for blood to escape. You do have to wonder though why women's bodies and their years of evolution would let them bleed to death after giving birth

Can't imagine why a woman would prefer to be hanging around waiting with a minging umbilical cord hanging out from between her legs. I recognise I am squeamish but that makes me feel sooo gross. I had the jab and placenta delivered in 4 mins, I didn't even notice. Good thing too as I ended up having 3rd degree tear and wizzed off to theatre.

I find the idea of a natural 3rd stage horrifying. But that's just me. I tore so badly because I couldn't bear feeling DS's head sticking out of me with his body inside so pushed for all I was worth, for me, once the baby is out the rest of it needs to be out pronto. Ick.

My managed third stage had me dangling over a bed pan with a cord and clamps hangin down dripping blood everywhere, catheter inserted, MW tugging on cord, nearly going to theatre. Couldn't hold the baby with all that going on.

My natural third stage had me lying on my bed BFing and cuddling my newborn who was still attached to me and not whisked away to be weighed, checked and dressed, few pushes and 20 mins later it came out by itself. Less lochia as well.

I know which way I preferred it.

Some people just don't like having artifical hormones injected into them if they don't need it TBH. As angry wasp said evolution would suck if we all bled to death not having the injection.

It's so routine now though MWs are often a bit shocked when you say you would prefer not to have it. I think there is a culture of baby out, cord cut, injection, placenta out, women cleaned up, baby dressed and on to the next one

I don't think it is quite as 'conveyor belt' like as you think though, although I'm sure some hospitals are worse than others.

In my own experience, I was in a medium-sized maternity wing of a big hospital, yet I was the only woman who had a baby that whole day.
I did have the injection, but there didn't seem to be any rush about the proceedings at all, baby was brought up skin to skin for quite a while before being weighed, checked and dressed by the midwifes, for which I was grateful...I'd never had a baby before, and it was a long time since I or Dp had handled one. We then stayed in the delivery room for a good few hours, all at our own pace.
Are the majority of folk here who seem so well-informed about this second-timers? And if not, how could you have been so sure of yourselves the first time round?
I am much more informed about my choices next time round now though, although I'd probably still waiver towards having it, for the same reasons mentioned by EricNorthmansmistress.

I requested not to have the syntometrine for my second labour as I had a retained placenta the first time. After much reading I felt that the cause for my retained placenta may have been contributed to by the syntometrine so decided to go without the 2nd time round. There is a very good booklet available from AIMS about having a natural or physiological 3rd stage of labour. It very clearly states that as long as labour is straightforward, there is no medical intervention or drugs used during labour a natural 3rd stage should be fine. The key being that the normal birth hormones that allow the placenta to come away are not disrupted.

I had quite a quick 2nd labour, 2.5 hours in total and although I had gas and air during the labour I had a natural 3rd stage. The placenta was delivered in around 45 minutes with no syntometrine and a far smaller blood loss than my first delivery. Do bear in mind that it is possible to have sytometrine if needed at any point after your baby is delivered for example you can wait for the cord to stop pulsating. Good luck with making you decision.

If I hadn't had the problems I had 2nd time I wouldn't even be thinking about having/not having the injection this time.

Like ericnorth said I had it and didn't even notice both times- it was only when it started going wrong after the injection with the placenta being retained.

I'll do anything to avoid all that this time.

And I didn't feel conveyor belt ish the first time but the 2nd time I felt like the unit was too busy really and they left it and left it before taking me theatre meaning I lost lots more blood than necessary.

Two homebirths, first very long and Midwife said I
needed it. I agreed and it was fine. Second time I put it in birth plan. Made me feel very nauseous, so had jab, which worked really well.

Am glad now I didn't have natural 3rd stage as to be honest just wanted it all over and done with and to get on the sofa!

I haven't read the whole thread but I think it's insulting and ignorant for the midwife to suggest to you that you are stupid not to have it.

To put a different perspective on it, rather than reduce the bleeding, in my case, when I had dd1 (after a labour with lots of intervention) it caused a PPH - and the staff admitted they thought this had been the case.

I do think that if you want to avoid having it, it is best to avoid as much intervention as you can, especially epidurals.

For dd2 and dd3 I had active labours and after I gave birth said no to the injection. The placenta came out by itself, in both cases within 10 minutes.

The bleeding after I had dd1 was awful - huge clots in the bath for 6 weeks, but for the other two it was just like a light period for a much shorter time.

So I would always try to avoid it, but obviously there are some situations where you can't......

Thank you again for sharing your experiences.

They have given us lots to think about and feel better informed about making the best decision for us, instead of following 'standard procedure' and being made to feel silly when asking about potentially important information. The antenatal class midwife definitely did not give us the full picture and am grateful that we now have the opportunity to state our preferences rather than having things imposed on us, which we might look back on and regret. Mumsnet has been a revelation and as a first timer, the information on here has been invaluable.

We have decided to wait until the cord stops pulsating before it's cut and if there are no complications and the delivery has been straightforward, would like to try to breastfeed and deliver the placenta naturally, hopefully giving my body a chance to do its work. It gives me piece of mind to know that we have the option of having the synto at any time after the birth rather than in a mad rush as soon as baby is out.

Good luck to all.

hope it all goes well, mumabee

Thank you becksydee.

So much to take in, so little time left...EeeK!!! [terrified face emoticon]

I had my first baby four weeks ago- home water birth. Ithe plan was to deliver the placenta naturally but when the time came I was so caught up in staring at my new baby I just wanted to get the placenta out and focus on feeding him. No sore leg or other issues and would do the same again.

i know, but you'll be fine! and you get a lovely baby at the end of it!

This thread is brilliant. I'm 36 weeks with my first and currently writing my birth plan. It's really helped.

I do have a question though - I'm happy for my baby to have vitamin K, but I want to try for a natural third stage. When do they usually give the vitamin K injection? Would they have to wait until after I've delivered the placenta?

I had nothing against having the injection, but turned out I didn't need it at all, had some mild contractions 15 mins after birth, did a little push as told my midwife and it was half out, one big push and it was all out

I@ve had both injection and natural 3rd stage and, TBH, there was no difference between the two. Natural took longer, that's all.

fairycakebump I opted for vitamin K oral droplet instead of injection for my baby.
Midwife came out a few hours after birth to give it to him x

mumtotwoboys, you not name changed yet? lol!

Did not know you could opt for droplet, will ask about that tommorow, midwife coming to book my homebirth!

x

I've had two managed third stage, two natural.

The two natural were after home births and took no more than 15 mins to deliver the placenta. The lochia was noticeably less and lasted a far shorter time.