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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

managed 3rd stage and postpartum oxytocin IV - necessary?

21 replies

MamaChris · 02/05/2010 14:22

I am pregnant with twins, and my hospital's policy specifies a "managed 3rd stage" (I don't know if this is syntometrine or syntocinon sp?) followed by 40 IU of syntocinon by IV.

Is this necessary/appropriate? I understand there is increased risk of pph with twins, but I also understand there is an increased risk of retained placenta with managed 3rd stage. Will 40IU (over a couple of hours) mean I continue with contractions all that time?

Also, the official syntocinon patient information leaflet says 5IU is the appropriate dose for prevention of pph, with 5-20IU following if needed.

I can't find studies of this sort of postpartum usage. Does anyone know more? I plan to have no epidural, if this is relevant.

OP posts:

Elasticwoman · 02/05/2010 16:53

I had a managed 3rd stage twice, and a physiological 3rd stage for my 3rd birth.
I didn't have twins though.

With the injection (don't know which drug was in it) the placenta was expelled in a matter of minutes. With the physiological 3rd stage ie no intervention, it took about an hour of quite painful contractions but placenta was finally out and it was an unusually big one. I was anaemic after the birth - photos show me same colour as the sheets while dh and mw look like they've been holidaying in the Caribbean! I lost quite a lot of blood but only started taking iron about a week later.

Original poster

MamaChris · 02/05/2010 19:26

Your physiological stage sounds tough.

I had a managed 3rd stage after ds was born and it was fine. But this time they are proposing to follow than with a syntocinon drip for 2-4 hours. I am wondering if anyone has had that and can tell me how it will feel (will I still feel like I'm in labour?), and whether the high dose (40IU) is justified.

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NanBullen · 02/05/2010 19:41

I think i had this drip after having ds. sorry can't remember the exact name but it made me have contractions again and after an hour was screaming in agony again so not ideal! And I still had to go into surgery to have the placenta removed plus a pph.

I don't know if you plan to have an epidural during the birth but I wished i had had one (Wanted one but no one available to give it to me ) It would have helped me whilst being on the drip. screaming in agony instead of holding your newborn is not how i imagined it would be!

Sorry, probably not what you want to hear

EldonAve · 02/05/2010 19:48

I think 40 IU is normal if you have the drip
That's what has been suggested for me - I'm not expecting twins but I'm at higher risk of postpartum bleeding

stripeyknickersspottysocks · 02/05/2010 20:00

It is normal protocols in most hospitals that a twin delivery is followed by 40iu of syntocinon. The reason its 40iu is because its diluted in 500ml of saline. The 5iu is diluted, but is a one off IV injection via a cannula.

I've never known anyone who's had the drip to still be in labour type pain with the drip. It does seem like from Nanbullen's experience that it can happen but it must be rare. I have known women who haven't had the drip still be in agony afterwards from afterpains.

I do know an experienced m/w who tends not to bother putting the drip up but has it prepared in the room ready to be put up if needed. I wouldn't recommend it as its better to not have any bleeding rather then be trying to get it to stop iykwim but if you're really against the drip then it could be an option.

Original poster

MamaChris · 02/05/2010 21:18

NanBullen that does sound awful. I was separated from ds after his birth, and the first few hours postpartum this time seem to matter to me more than the birth this time round.

skss somewhat encouraging you've never known anyone to still be in labour type pain with it. Can I ask how many people this is based on? Obviously don't want to risk pph, but also want to start getting to know my babies right away once they are born...

OP posts:

stripeyknickersspottysocks · 02/05/2010 22:00

Am a m/w, so probably a couple of hundred.

NanBullen · 03/05/2010 07:19

had a look at my notes, was given syntocinon and syntometrine (sp?) and then lost 1500 ml of blood.

Interesting (and quite relieved) to hear that it's unusual to have labour type pains. I've actually been putting off having another dc because of this experience so maybe i was just unlucky.

NanBullen · 03/05/2010 07:27

sorry to keep hijacking this thread, but just clicked on the link above and it says that an overdose of syntocinon can cause very strong contractions. Is this maybe what happened to me?

It doesn't say on my notes how much i was given but I'm a bit if i was given too much and wasn't told.

Original poster

MamaChris · 03/05/2010 07:55

thanks skss, very good news then

NB - not highjacking at all - all relevant info. As I understand it, at my hospital the drip will be used after the delivery of the placenta. Am not medically qualified, but it does sound like yours was started while placenta was still in situ. Maybe this could be a problem?

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NanBullen · 03/05/2010 07:58

Exactly MamaChris. I just assumed they were using it to get the placenta out but when it didn't work i then had to go into surgery.

hmmm, if i do get pregnant again will have to talk to my gp about this...

I should have questioned at the time but tbh i think i was in shock and then just wanted to go home and try and forget about it (which clearly i haven't!)

Loopymumsy · 03/05/2010 08:08

This reply has been deleted

Message withdrawn

Original poster

MamaChris · 03/05/2010 08:11

I think you can ask for someone from your hospital - a senior midwife or doctor? - to go through your notes with you to understand what happened and why. I'm not sure of how to go about it, but a friend did this after a traumatic assisted delivery. I can find out for you if you like? It sounds like you do need some specific answers, and a gp might not be best qualified to interpret everything.

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Original poster

MamaChris · 03/05/2010 08:15

Loopymumsy, that's very reassuring to hear. Sorry you had to transfer in after homebirth though. I had to with my ds because he wasn't too well and it wasn't much great to be in hospital when we'd planned to be at home.

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NanBullen · 03/05/2010 08:16

Thanks mamachris that would be helpful. we're ttc no 2 at the mo and i'm planning on asking for an elcs bcause of what happened the 1st time.

Original poster

MamaChris · 03/05/2010 08:32

OK, I'll ask how she arranged it and get back to you. Check this thread in a couple of days. And good luck with ttc

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trafficwarden · 03/05/2010 16:31

I agree with Stripey on this one. Having worked in markedly different units in different countries, the advice is the same. The risk of PPH is increased with twins and prevention is definitely easier than management.

If you can imagine your uterus has been really stretched to provide space for two babies, it has to do a lot of work for the musculature to shrink it back again. Add on the size of the area which was supporting two placentas (or one large one depending on the type of twins!) and that translates into a large raw area inside your uterus with lots of blood vessels which have to be clamped down to stop the bleeding. It is a complicated and contrary process with a single baby and placenta and so the risk increases with twins. I'm not saying your body will not work effectively, it just might need a hand when it is tired after labour. I hope my simplistic explanation doesn't offend anyone who already has a good grasp of the anatomy and physiology involved!

If you can access the Cochrane database there is lots of info - lots of public libraries have access in the UK and it is public access in Australia.

The pain aspect is difficult to quantify as, like labour itself and afterpains, some women manage fine and others find it very unpleasant.

Good luck wth your labour and keep asking your Midwives and Obstetricians for all the details.

Original poster

MamaChris · 03/05/2010 19:00

Thanks trafficwarden. I am not anti the syntocinon itself, and do want to avoid pph. I just wanted to understand how appropriate this dose was (sounds like it is appropriate), how it will feel (variable, but probably not awful), and whether I will be able to start getting to know and feeding my babies during that time (no reason why not, as far as I can see, presuming the postnatal bed is wide enough to accomodate me and two babies).

I'm not due to meet the consultant till 24 weeks, and not due to see the midwife again till 25 weeks. As I'm 17 weeks now, that's a while to wait - I expect I'll have a long list of questions by then!

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Original poster

MamaChris · 07/05/2010 13:34

NanBullen my friend says they went through the Patient Advice and Liason Service at their hospital to ask to talk through their notes with a midwife. But she also pointed out that if you are pregnant again, then you might be able to ask your midwife to be put in contact with a supervisor of midwives or other senior midwife to do the same. Good luck, I hope you get the answers you need.

OP posts:

NanBullen · 26/05/2010 19:58

Thanks (belated sorry!) have just found out i am pregnant so will take your advice

e3chick · 26/05/2010 21:37

MamaChris, I had twins and had a managed 3rd stage. I was already on the syntocinon because my contractions didn't get going again for no. 2 so I had to finish off the bag. Then I had a slow-ish pph and I was onto another drug (syntometrine??) for about 4 hours.
In my case it was unavoidable and necessary. I don't know the dosages (and am VERY impressed that you do and are questioning that!), but it only made me feel grotty, I did not have any major contraction like pains at all. The worst bit by an absolute mile was as someone said earlier, that having the tube in my right wrist while the bag of saline solution was over on my left hand side was quite an impediment to getting used to handling and feeding two babies. It really got in the way.

And don't believe the bed is wide enough for the three of you.

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