Natural or managed third stage?

[Emster30]

Am trying to write my birth plan, and this is the one bit I don't really understand. I can't see any particular reason not to have the injection. I would be grateful to hear what other people think or have done. Is a managed third stage just a decision people make because they want things to be as natural as possible, or are there other things to take into account?

Tbh I've been grateful of a managed third stage in both births. I didn't notice the injection and it meant it was over while I was still in the birthing position iyswim. Then I could get up and have a cuddle and a rest. But I am sure there are arguements for a natural third stage, but based on my 2 births, I have been happy with a managed third stage, and still consider myself to have had a natural birth

The injection "closes down" your uterus really quickly which in theory help to stop you having a PPH. However, it also means the MWs have to get the placenta out fast before the uterus closes, meaning they may need to physically yank it out by the cord, hence you are more likely to have retention of bits. It also, I think, means the cord is cut straight away, without the blood being returned to baby.

The injection isn't completely risk free and has possible side effects, including possibly making your blood pressure very high. So some people decide to have in their birth plan that they'll have it if the midwife considers it medically necessary, but don't want to have it as routine.

nhs.medguides.medicines.org.uk/nhs/medicine.aspx?name=Ergometrine maleate/Oxytocin&use=Labour (preventing bleeding after)&preparation=1&section=sideEffects

An interesting read:

www.bellybelly.com.au/articles/birth/natural-approach-to-labour

My two natural 3rd stages took 20 mins and 9 mins, and I was cuddling baby and unaware of both until it slipped out on its own.

Thanks, that's helpful to see arguments for and against. I like the idea of having it only if advised it's medically necessary.

I had a natural 3rd stage last time and will do so again - I like the fact that the blood returns to the baby and it was no hardship to lie on the beanbag for an extra half hour cuddling my baby waiting for the cord to stop pulsing.

I went for natural in my birth plan unless medically necessary as I was worried about the side effects.

In the end I had the injection as I was losing a lot of blood although we now know it was because I'd tore.

I found the contraction caused by the injection really painful! More than my actual contractions. But it was really quick and placenta came out fast.

I had natural 3rd stage with DS2.

Chose this as VBA2C and risk of retained placenta increases after sections, and also wanted to not cut cord until stopped pulsating.

Have to say it wasn't exactly great fun - took 59 minutes to finally deliver placenta, midwife had to scoop it out - a minute more and they would have been whisking me up to theatre. But not at all painful and probably the right decision for me.

Why not keep an open mind and decide at the time?

Most Mums just want it over with but as another poster has said you can take a middle road which has huge benefits to your baby.

Leaving the cord to finish pulsating for a few minutes is now recommended by the WHO so that your baby is at less risk of being iron deficient.

Tracy

www.GentleBirth.com

I had a natural 3rd stage second time round as I had a retained placenta the 1st time and was keen for that not to happen again. After reading loads I felt that one of the main reasons that the retained placenta had happened was due to the syntometrine.

AIMS do a brilliant booklet that you can order on their website about the 3rd stage. The key to having a 3rd stage without syntometrine is that you avoid as much intervention as possible during labour so that your body responds naturally to delivering the placenta. So to some extent the decision is dependent on how your labour progresses but it is worth looking into.

I had injection and had a retained placenta that had to be manually removed in theatre. I am expecting again and have spoken to the consultant about this as I really don't want to have to go through that again, it is degrading and knowing everything that is going on has left me a little scarred really.
Anyway, I was told that as my placenta was stuck to the womb lining and not trapped by the cervix, then it is unlikely that the injection would have made any difference, not having the injection may have resulted in the same situation, but with a longer delay to get to theatre.

I have to go back at 36 weeks and let them know what I decide or go through my concerns and get some more advice. I haven't a clue what to do really. Have been told I may be better having GA if it does retain again which is a lighter burden. However deciding what to do about the injection is messing my head really. I will be ordering the AIMS booklet, but from what I have read on there already it hasn't aided my decision, hoping booklet is a bit more informative.

I had a natural third stage. I wanted the baby to get the extra blood, and as he had feeding problems later and lost a lot of weight and got quite jaundiced I was glad of the decision, little difference though it may have made. I was so stoned anyway from G&A it made no odds - I just sat in the pool cuddling DS till the midwives said it was time to birth the placenta. All very calm.

I'm very pro conventional medicine as a rule. I wouldn't dream of refusing the Vit K jab, all vaccinations up to speed, and so on. I just saw no reason to have the jab, and a couple of mild ones against it.

I wrote a natural third stage into the birth plan for my first delivery. However, after a hugely long second stage and a lot of blood loss it was felt to be too risky and tbh I couldn't have cared less at that stage. I was more than happy to agree to the injection and it was just fine and very easy.

Second time around I didn't bother with a birth plan and any thought of a natural third stage was the absolute last thing on my mind. Had the injection no problem and I was more than happy to let the MWs do the work for me.

I was the same as confuzled - just cuddled DD in the pool and then felt the placenta "drop" (sorry if tmi) and one small push and it was done. I was glad to be able to keep the cord intact until the transfer of blood to DD was complete. I had the drugs in my fridge and the MW had them drawn-up ready if I had bled. That's the beauty of it, you can wait and see and have it if you need it and not if you don't.

FWIW, I had 2-3 days of heavy bleeding post-birth, and then practically no loss at all. MW said that this often happens with a physiological 3rd stage - managed 3rd stage results in longer but not as dramatic flow. Not sure how true this is as haven't checked the research, just anecdotal.

"I had 2-3 days of heavy bleeding post-birth, and then practically no loss at all."

Again just anecdotal, but same for me.