ADVICE WITH RETAINED PLACENTAS

[GEM4]

IM NEW HERE SO HI, WONDERING IF ANYONE CAN HELP ME
WHEN I GAVE BIRTH TO MY DAUGHTER(ONLY CHILD BUT NOW PREGNANT)I WAS 10 DAYS OVER DUE AND IT WAS A SPONTANOUS LABOUR,THE LABOUR WAS QUICK, NO TEARING,HAD NO PAIN RELIEF SO I WAS LUCKY. MY MIDWIFE THEN TRIED TO REMOVE THE PLACENTA FOR QUITE A WHILE(GAVE ME THE INJECTION TO HURRY IT ALONG)THIS DIDNT WORK.THEY TREID A FEW THINGS FOR WHAT SEEMED LIKE FOREVER AND THEN STOPPED.THIS BEING MY 1ST I DIDNT KNOW WHAT WAS GOING ON AND WASNT WORRIED AT THIS STAGE.SOME TIME LATER I HAD A DOCTOR COME IN AND WITH OUT TELLING ME OR GIVING ME PAIN RELIEF, PUT HIS HAND INSIDE ME AND PULLED THE PLACENTA OUT, THEN BEGAN TO TEAR AT IT TRYING TO GET IT OUT. HE HAD SCISSORS IN HIS HANDS(DONT KNOW WHY AND MIDWIFES WERE SHOCKED AT HOW HE WAS DOING THIS)HE THEN MANAGED TO CUT ME LEAVING A 2ND DEGREE CUT.CANT REMEMBER EVERYTHING EVEN NOW,ITS LIKE IVE BLOCKED IT OUT. CANT EXPLAINE HOW PAINFUL IT WAS AND AT ONE POINT BLACKED OUT..HUBBY WAS TOLD THIS HAPPENED AS I WAS O-NEGITIVE. IM NOW PREGNANT AGAIN AND PETRAFIED OF GOING THROUGH THIS AGAIN PHYCHOLOGICALY. FEEL DEPRESSED AND SCARED. I AM TO SEE MY CONSULTANT ON THE 11TH. I WANT A C/S BUT AM SCARED THAT HE WILL FOB ME OFF WITH AN EXCUSE. SHOULD I ASK TO SEE MY NOTES FROM LAST LABOUR. ANY ADVICE WILL REALLY HELP,PLEASE

Wow gem4 that sounds horrific. I'm sorry I have no advice for you but I think I'm right to say you have every right to see your notes from your last labour?

It sounds like it would help you to really talk through what happened the first time round, to help you come to terms with it and to deal with your fear. FWIW i was very medically phobic when i fell pregnant and somehow got through the whole thing, I'm sure you will too. Talk to a professional to set your mind at rest.

Good luck x

PS you have every right to do it your way, this is your life & your body - if you feel very strongly you want a C/S then be assertive and ask for it!

Hi,
i also had problems delivering placenta ( i am o-) Luckily they removed it after giving me drugs but not in one piece, they left some behind which caused infection a few weeks later.If you are o- it needs to be removed as quick as poss so babys blood doesnt come into contact with yours.

GEM4 - you need to discuss what happened with your consultant. Are you going to give birth at the same hospital? If so, your notes will be there. That was an awful experience for you and the midwives should have stopped it. Rather than have a C/S you should be reassured that this will never happen to you again. You should have had the placent removed under spinal anaesthetic in theatre where you would be awake and not feel anything. There is a good chance that it would not happen again this time. The fact that you are O negative has nothing to do with it. It might be better not to have the injection next time if all is normal because there is less likelihood of blood crossing from baby to mum when the third stage is physiological (placenta delivering without aid of drugs). Retained placenta can actually be caused by one of the drugs that is given by the midwives ( the ergometrine in syntometrine).
Please discuss this with your consultant and midwife. You need reassurance that you will not be treated like that again, not that you need a C/S.

Am interested in this as it took the midwife 50 mins to deliver my placenta after DD, I had the syntometrin (spp) as she was being born I think. The midwife (whom I wasn't that impressed with) then tried giving it a gental tug, getting me up off the bed and hovering over a bed pan (gravity??) that was fun. Then she inserted a catheter and drained my bladder. She then said she was going to give it one more go if not I would be going for a manual extraction, I assumed this was under spinal in a theatre. I was getting a bit upset by this as I also had a straight forward delivery with just g+a and didn't fancy a spinal. Luckily at the last attempt it came out. I'm O+.

Question for mears really - whats the likelihood of it happening again (i'm hoping for a homebirth this time) and also whats the background for giving syntometrin would I be better delivering naturally and also is there and time limit on delivering the placenta, ie why was I not allowed to go past the hour mark?

Sorry for hijacking your thread a bit Gem

Hi sweetkitty - haven't got a lot of time (just going to work) but if you do a search for physiological third stage and mears you will find a lot of info on previous threads.

When syntometrine is given the placenta should be delivered preferable within 10 minutes. The ergometrine component of syntometrine makes the cervix close down and trap the placenta. The midwife did the right thing emptying your bladder because a full bladder can retin the placenta too.

The time limit of 1 hour (can actually be longer) is for physiological third stage where no injection has been given and nature does the job. Physiological third stage is fine where there has been no intervention in labour such as painkilling injected drugs, drip to speed up contractions or epidural etc.

In waterbirth we have physiological third stage and have foundit ranging from 10 mins to 2 hours. The baby breastfeeding encouraes the placenta to deliver. HTH.

What about the membrane? They couldn't find the membrane and said it had never happened before, but discharged me anyway as I wasn't losing huge amounts of blood (as I did giving birth). I "gave birth" to it a week or so later at home, none of the HVs would listen to me when I was on about it, and I knew something still wasn't right once I got home. i've just had to trust ever since that all is well.
Sorry i'm hijacking even more than the others...

I have a bicorneate uterus and had a retained placenta with my first child. It was removed manually in an operating theatre while I still had my epidural working and I didnt feel a thing. I was told that it's more likely to happen a second time but I was fine with my next two children. I'd definitely be assertive about what you want to happen if it were to be retained again. Lesley

Get your notes to see what they said on this - sounds terrible for you to have to go through. Talk it through with m/w. Get it down that if you don't have a cs you'd like a spinal if placenta is retained. I had a retained placenta & hamorraged straight after giving birth. Will be asking my doc how likely it is for it to happen again. Best wishes xxx

OMG Gem4 how terrible for you . I don't have any real advice but thought I could share my experience with you. I had a fast unplanned home birth with DS and retained the placenta despite injections. I was taken into hospital after 2 hours and spent another 5 hours on a syntosin drip - they had clamped the remaining part of the cord and pulled gently on it - but it didnt budge at all . It was eventually removed by a surgeon under a spinal block who told me it had been still entirely attached. I was told I do have an increased risk of it happening again. Turns out my mum had a similar experience with my eldest brother but not with my younger brother and I. Ive also read that having a drug free third stage might make it less likely. I reckon you should be allowed whatever birth you will feel happiest with but if you have advance warning that placenta retention might happen again, then you could set out how you want it to be managed if it does. From my own experience, active birth classes really helped me feel in control - your first stages sound so positive I would have thought you'd be an ideal candidate ...

thanks mears I'll have a look in a bit

I am thinking about a physiological third stage now and not having the injection (my thigh hurt for a few weeks afterwards as well)

Hi gem4 only just seen your post.also went through this. had real psychological problems afterwards- depression, flashbacks petrified of getting pregnant again and when i did with ds2 all the midwives were dismissive and said it 'probably' woudn't happen again. i was a wreck for 2 years after birth and 7 months of my pregnancy. i researched like mad and found out the following info: with previous retained placenta you have a 50% chance of it happening again. if you really want a c/s there is a website called www.thelancet.com. register your details and search 'hinchingbrooke'. this is a detailed report on active versus expectant management during third stage of labour and gives you all the statistics you will need(0.02 percent difference with active compared to managed 3rd stage) to argue your case for c/s. i kept seeing different midwives until i found one that really understood what i had gone through. the consultant tried to encourage me to go through trial of labour first or give me the option of being under general if it happened again . i explained that the brutality of the procedure felt outside of its medical context like being raped and that the option of a general anaesthetic if it happened again wasn't condusive to a postive pregnancy or labour. don't be intimidated, (they are trying to reduce c/s rate -currently nearly 25% of all births) take notes about your experience and reasons why and/or midwife with you at appointment and get a sympathetic doctor and midwife to write a referral supporting your request.
just checked lancet website and they are now charging for the information - could ask doc/midwife/nhs direct to print the report out in full on your behalf. once i was given the date for the c/s i finally relaxed and enjoyed the last month of my pregnancy. the positive experience of the c/s healed the psycological scars of the first birth and have just had my ds3! if you need any more info or want to talk about it cat me. the very very best of luck.

THANKS SHRUB. I SAW THE CONSULTANT AND HE SAID THERE WAS A 10% CHANCE OF IT HAPPENING AGAIN BUT I KNEW IT WAS 50%,DIDNT SAY ANYTHING THOUGH,WISH I DID. HE TOLD ME TO HAVE A NICE EASY BIRTH WITH A EPADURIAL(SORRY SPELLING). I FELT LIKE A TWIT THAT WAS WASTING HIS TIME. THE NURSE THAT WAS THERE WAS GOOD AND YOU COULD SEE FROM HER EXPRESSION THAT SHE WAS SHOCKED AT WHAT I WAS SAYING AND WHAT HIS REMARKS WERE.
WHAT YOU SAID ABOUT IT FEELING AS THOUGH YOU WERE RAPED IS SO TRUE. I HAVE TRIED NOT TO SAY THIS AS I DONT WANT TO UPSET ANYONE BUT THATS HOW I FEEL, EVEN WHEN I SAID HE DIDNT SAY WHAT HE WAS GOING TO DO, HE JUST DID IT WITH MY HUBBY SAYING THAT HE FELT HELPLESS AND LIKE HE LET ME DOWN WHICH I DIDNT KNOW TILL THEN HE STILL SAT THERE TELLING ME IT WONT HAPPEN AND IF IT DOES THEN IT WILL BE O.K.
IT HAS TAKEN ME 3 YEARS TO GET PREGNANT WITH THIS ONE AND I BELIEVE THAT THIS EXPERIENCE WAS SOME WHAT RESPONSABLE FOR THE WAIT, BUT ALSO IN NIEVITY THOUGH THEY WOULD GIVE ME A C/S THE NEXT TIME BECAUSE OF MY FEELINGS TOWARDS THE LAST BIRTH. GOD WAS I WRONG. IM GOING TO SPEAK TO MY MIDWIFE ON TUESDAY TO TALK MORE ABOUT THIS AND HOPEFULLY SHE CAN HELP.WHAT SCARED ME ASWELL WHEN I FIRST SAW MY MIDWIFE AGAIN WAS THAT SHE WASNT AWARE OF THIS HAPPENING WITH MY PREVIOUS BIRTH. APPARENTLY MY NOTES WERE LOST.
THANKS AND I WILL HAVE A LOOK AT THA WEBSITE.
ALL THE BEST
GEMXX

gem4 - if you really want a c/section then you are entitled to it. i don't want to contradict any other advice on this thread but when i presented the hinchingbrooke report to the consultant he was aware of the statistics and agreed. i said if you can guarantee that this won't happen again then i will go through with a vaginal birth but he couldn't. i also stressed that the fact that i would prefer a major operation to the risk of retaining the placenta again and post partum haemorrage should make him realise how profoundly the procedure had affected me. if your midwife isn't listening to how you really feel about this then book a appointment with your head midwife/doc, and if your doc isn't listening then get a second opinion. if you need any further support about this please cat me - i will come with you if you want and are any where near devon as i feel so strongly about this and know how difficult it is to make anyone understand how brutal and violent the experience is unless they have gone through it. sending hugs and lots of feisty assertiveness your way, the sooner you can resolve this, the sooner you will be able to enjoy the rest of your pregancy and look forward to meeting your lovely baby xx

gem4 - How are you feeling and did you manage to speak to your midwife?

EVENING SHRUB.
I HAD A MIDWIFE THAT WAS COVERING FOR MINE TODAY AND SHE MADE IT OBVIOUS THAT SHE WASNT GOING TO HAVE HER TIME WASTED BY ME. I FORGOT TO TAKE A URINE SAMPLE AS THE MIDWIFE DIDNT GIVE ME A POT. I TOLD HER I WOULD GO AND DO A SAMPLE BUT SHE MUTTERED SOME REMARK ABOUT MOTHERS NOT CARING ETC ETC SO TO BE HONEST I COULD NOT BE BOTHERED TO TALK TO HER. IM FEELING MORE INCONTROL ABOUT EVERYTHING NOW AND IM READY TO FIGHT MY CORNER ABOUT THIS. I HAVE A SCAN FOR 21ST SEPT AND IM GOING TO BRING IT UP AGAIN THEN,IF THEY DONT LISTINE IM GOING TO GO OVER THERE HEADS.THANKYOU,YOU REALLY HAVE HELPED, SPEAK SOON GEMXX

I don't know whether this helps or not but I had a retained placenta with dd2 despite various members of staff coming in and having a forrage around to see if they could remove it, didnt with ds1 and then had one again with ds2.

HI SHRUB.
QUICK QUESTION IF YOU DONT MIND?.I JUST READ ON ENOUGHER SITE THAT THEY CAN CHECK TO SEE IF THERE IS A CHANCE OF A RETAINED PLACENTA/ACRETTA ETC BY HAVING A SCAN(A 4D SCAN).I THINK AROUND 30 WEEKS.DO YOU KNOW ANYTHING ABOUT THIS?IS IT ALL RUBBISH OR IS IT WORTH PAYING PRIVATE TO SEE?

ALSO HOW FAR DO YOUR WISHES GET TAKEN INTO CONSIDERATION BEFORE THE DOCTORS CAN OVERULE YOU?FOR EXAMPLE IF SOMETHING HAPPENED WHILE DELIVERING DO I HAVE THE RIGHT TO SAY ABOUT A C/S OR NOT.SORRY FOR ALL THE QUESTIONS AND THANK-YOU.
GEM

Hi Gem4 - didn't have the option of 4d scans at my hospital so can't answer that question. All I can say (or speculate) is the statistics that I found through the research. I would think that a 4d scan could give you an indication but not a definative answer ie. visable scar tissue from previous birth that would further the risk of retained placenta but the placenta could also be retained due to other factors - syntometrine injection, excessive cord pulling, exhausted uterus clamping down trapping placenta, the cord being clamped and not feeding baby immediately. These are only some of the factors that I am aware of.
With regard to second question - If you are saying that you really want a c-section because of your previous birth - you absolutedly have the right to ask for a c/s I would most definately say yes. The reason for me being able to get the c/s was because I (eventually) had a really understanding midwife who supported my request and listened and saw how much it had affected me and was affecting my pregnancy. It was put under the reason as 'previous traumatic delivery'. Mine wasn't an isolated case as I have now had 2 c/s and had to discuss my request each time. Both times the midwives and consultants mentioned they had given elective c/s for the very same reasons as other women had also been badly psychologically damaged. I have a friend who is a nurse who had a forceps delivery and was so traumatised by it that she had a c/s for her second delivery. Another friend had a ventouse delivery for her first and again because of her feelings towards the birth managed to request a c/s. One woman I know who had a retained placenta is so frightened of it happening again she is too scared to have more children because of her fear of the same thing happening again.
Your reason for wanting a c/s is completely valid. I would write all your experience down, how it affected you and how you are feeling now and take it to the midwife(s), doctor and ask to see the consutant again or another one. They may be testing you at first to see if really feel that strongly about it - horrible way to be treated as you are a genuine case not one of the media headlines 'too posh to push'.They may discuss the many risks of c/s versus natural birth but personally i found the physical risks of c/s preferable to the psychological risks if i had another retained placenta plus the increased risk of post partum haeomorrage and even removal of the uterus in extreme cases! i found the manual removal a barbaric almost vetinarian procedure. don't let them patronise you the next time you see them. have your research and notes ready and take dh/family/friend with you.
have you managed to get the info about the hinchingbrooke report yet? it should really help your case. I would also try googling 'groups' aswell as the net as you may get more info. Even though i didn't know until i was 8 months pregnant that i could have a c/s i had during every visit with the midwife (i very rarely had the same midwife during a check) discussed the retained placenta and how distressed i was and how worried i was about it happening again - this was put in my antenatal notes each time so again this might have helped my case being put forward to show how serious i was about how it had and was affecting me ie. flashbacks, anxiety, trouble sleeping, very tearful etc.
best of luck for your next appointment
hope and hugs
xxxx

Having the syntometrine injection makes it more likely that you will have a retained placenta.
Have you thought about maybe having your baby at home next time and refusing the injection?
I think that would make a huge difference to you, and since retained placenta is not immediately life threatening I can't see any reason why you wouldn't be considered suitable for a home birth. Then you would be in control and nobody is allowed in your house without permission. You also don't have to get permission to do anything and all the evidence shows you're more likely to give birth easily and feel less pain.

HI THERE.THANKS FOR POSTING. NO I HAVNT CONSIDERED A HOME BIRTH TO BE HONEST,IM A LITTLE MORE RELAXED ABOUT THE WHOLE GIVING BIRTH THING AGAIN NOW BUT AM STILL WAITING TO SPEAK TO MY MIDWIFE ABOUT IT. IF I DONT DELIVER THE PLACENTA EVEN WITHOUT HAVING THE INJECTION I WOULD STILL HAVE TO BE TAKEN TO HOSPITAL AND I MIGHT NOT BE ABLE TO HAVE A SPINAL IF THERE IS NO ANESITIST(SPELLING SORRY).A GENERAL IS NOT SOMETHING I WANT BUT ITS SOMETHING MAYBE TO THINK ABOUT AS MY LABOUR WAS QUICK AND EASY APART FROM THIS. THANKS, I WILL SPEAK TO MY HUBBY AND MIDWIFE.GEM