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Talk about every stage of pregnancy, from early symptoms to preparing for birth.

Deliver the placenta naturally?

29 replies

runlolarun10 · 31/05/2012 12:18

Hello. Just finishing off my birth plan. Am hoping for as natural birth as possible if things go to plan but am still undecided about delivering the placenta naturally. Confused
My thinking is, if I manage to get through it without an epidural I've done bloody well enough and maybe I'll just want to get it over and done with and have the injection, but on the other hand, if I manage as naturally as possible, surely I should try and do the last stretch?!
I would really like to delay the cord clamping, but is this possible if I have the injection for the placenta? Lastly, how much longer is it likely to be to deliver the placenta naturally: are we talking minutes?
Sorry for the long winded post: basically please tell me everything you can about getting placentas out! Smile

OP posts:
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ShushBaby · 31/05/2012 13:16

I have a slightly skewed view, given my experience, but it may be useful. I did have the injection, but still had a retained placenta (where it doesn't deliver). I haemmoraghed and had to go to theatre to have the placenta removed.

Apparently this may have been caused by the fact that my labour was long (16 hours) and my uterus was tired and sort of 'gave up'. Or it could just be one of those things.

Either way, I absolutely plan to have the injection this time- anything I can do to help prevent the same thing happening again. Having said that, it apparently didn't work last time! But that won't stop me having it again.

In my view, an injection may be an intervention- but it's a lot less of an intervention that being taken away from my baby for an hour to go to theatre, have a spinal, and have the placenta manually removed!

(I was fine, by the way. No major trauma. Just an unfortunate thing that I would like to avoid if poss).

ShhhhhGoBackToSleep · 31/05/2012 13:24

I am planning on having a physiological third stage (no injection) and delayed cord clamping as I will be busy snuggling my newborn and won't really care how long it takes to deliver the placenta! I think it usually takes 15-20 min but could be as long as an hour. It's not like you will be running a marathon or tap dancing during that time so not having the placenta out wont make a difference!!!

If i have to have an assited birth, it looks like I am losing a lot of blood or I get fed up waiting I will have the injection but otherwise there isn't any drawback to waiting for me (no history of pph or anything) so I'll give it a go then make the decision as we go along.

BoysBoysBoysAndMe · 31/05/2012 13:44

IMO with both of mine, I just wanted the whole thing over so I could cuddle my baby.

Can't tell you what happened with my two, I have no idea. I assume I had the injection with the first as it was out in a couple of mins.

And with the second I had a ventrouse delivery. No idea what they did with the placenta Confused

Personally, I couldn't care less- just give me my baby. You don't get any rewards for doing it all on your own. And I'd it's your first baby you don't know how you'll be feeling once you've popped out bambino.

It's fecking hard work Wink

Good luck and wishing you a happy and healthy baby

PeggyCarter · 31/05/2012 13:57

This reply has been deleted

Message withdrawn at poster's request.

TinkerMaloo · 31/05/2012 14:13

I bled heavily with my first and so with my second had the injection and the bleeding was minimal and meant I didnt have to stay in hospital for ever like the first time round. They recommend the injection for me following the bleeding the first time round.

Indith · 31/05/2012 14:25

You can decide to have the injection at any time so you can say you want a natural third stage so they don't jab you right away and then ask for it if you want it.

number 1 didn't know about delayed clamping etc so had it right away.

number 2 natural 3rd stage, delayed clamping.

number 3 delayed clamping but after an hour skin to skin and feeding I was so fed up, suffering with after pains and wanting a shower so they cut the cord and gave me the injection and placenta came right out :)

Bearhugs43 · 31/05/2012 15:13

Up to a third of your baby's blood volume is in the placenta and cord at birth. Blood (Inc stem cells of course) that is intended to get to your baby. The issue with early cord clamping is that it deprives the baby of all this, and also cuts off it's oxygen supply via the cord prematurely. Not doing this allows them more time to get to grips with the massive changeover going on in their circulatory system (it literally switches over) without there being an emergency need for oxygen.

Syntocinon or syntometrine can be given at any point after the cord is clamped anyway so the best course is once cord has stopped pulsating if desired/required for bleeding. This is now being done after a CS in theatre now in our unit (although they only give 1minute but better than none)

FWIW a managed third stage increases risk of retained placenta (ESP if syntometrine used as the ergometrine element clamps the cervix down quickly trapping the placenta if it has not been forcibly removed with controlled cord traction.

There is a massive body of evidence to support delayed cord clamping - even if you choose/need to have active management once the cord has stopped pulsating. HTH

ItsAllGoingToBeFine · 31/05/2012 15:21

I had delayed cord clamping, delivered placenta naturally and then had the jab...

runlolarun10 · 01/06/2012 08:14

Thank you for all your replies. Bearhugs, so I can ask for delayed clamping of the cord but then have the injection to deliver the placenta?

OP posts:
jkklpu · 01/06/2012 08:21

Had physiological last stage with ds3 after delayed cord clamping. Was out of the water by the time the placenta delivered - poss up to an hour later. I remember it being pretty painful with a midwife "encouraging" it out on my belly. In comparison, didn't really notice it with accelerated delivery after first 2 natural births.

Bearhugs43 · 01/06/2012 12:42

Yes - once the cord has stopped pulsating you can clamp it and either have the injection immediately if you are happy with that or at any point afterwards (midwives usually get twitchy after an hour but up to 2 can be within normal limits)

If you are waiting before having it then getting baby skin to skin and suckling produces oxytocin (the natural form of what is in the injection) which detaches the placenta from the wall of the womb so it can be delivered.

Obviously if there is heavy bleeding at any point it will be given immediately.

This all relates to normal labour and birth though - if there has been any intervention of any kind it is not usually viable (because drugs have already altered the physiological norm which increases risk of bleeding) You can still leave cord a few minutes to pulsate before having it in most cases though (be CLEAR that you want this before and during labour though or you'll find that injection in your thigh before baby's body is out in most units.

HTH

Tooodlepip · 02/06/2012 12:06

Hi

I delivered my placenta naturally on both of mine, to be honest I don't know much about the injection and the first time I wasn't asked if I wanted to deliver the placenta naturally they just sort of assumed because I had a water birth.

Anyway first time it was fine the midwife stood me up over the toilet and it just immediately came out.

The second time , I was left in a cold bath for 15 mins and I was not happy, I actually asked to be allowed to stand over the toilet again and it immediately came out then. I mean why would I want to lie in a bath of cold water with yucky stuff around me lol

Does the injection give contractions or something what exactly does it do??

maples · 02/06/2012 12:15

This reply has been deleted

Message withdrawn at poster's request.

Birthhippy9 · 02/06/2012 23:14

Bearhugs your words are very wise.

I had 2 natural 3rd stages. I don't see the point in disrupting a perfect good system. Birth baby, straight to breast the suckling encourages your womb to deliver your placenta at a pace that suits your body so it can close vessels in a controlled way.

Bearhugs43 · 03/06/2012 07:51

The injection is either syntocinon which causes uterine contractions that can force the placenta to peel off the wall of the womb. Then the blood vessels where it was attached shut off to minimise bleeding.

Some units use syntometrine which is syntocinon combined with ergometrine. The latter acts to clamp down the cervix. Hopefully after the placenta has been delivered - if it hasn't been removed quickly enough (through pressing on the belly and pulling on cord) then it causes retained placenta. Or cord snap.

Syntocinon is a synthetic version of oxytocin. It is given as an injection after birth for third stage and to (usually prophylactically) reduce bleeding. I have outlined the benefits of waiting before having it in previous posts.

Syntocinon is also given in much much larger doses via IM drip during induced or augmented labour. It causes contractions that are more intense but less effective than naturally produced ones- you need more contractions per cm of dilation. This is why it is generally administered alongside epidural, which usually slows labour further and increases chances of fetal distress and assisted/surgical delivery.

Syntocinon (when used during labour) is also an antidote to naturally produced oxytocin...

Oxytocin is the hormone the body produces naturally to cause contractions (uterine contractions, the let down contractions that cause expulsion of milk during breastfeeding and the contractions of orgasm - male and female too)

It is also responsible for feelings of love, bonding and intimacy in life generally - but is present in massive amounts in a mother and baby immediately after birth to start maternal love and bonding.

Unfortunately synthetic oxytocin (syntocinon) does none of these things - it's molecules are too large to pass across into the brain)

It inhibits production of natural oxytocin (which is why those who have laboured with it often look glassy or sunken eyed and shell shocked in those first few photos holding baby, where those who are high on natural oxytocin have large dilated pupils and look wide eyed (and feel as if they could conquer the world!))

Natural Oxytocin creates contractions which do not overwhelm our body, are manageable and effective. Syntocinon is labelled with a warning - may cause uterine rupture - the high doses frequently cause hyperstimulation which can lead to potentially fatal rupture. Which is why induction using syntocinon is especially dangerous for anyone who has had previous CS.

Natural oxytocin only produced efficiently by the body when we are feeling safe, warm and cared for. This is the same for all mammals (think about what a cat does instictively- finds dark warm safe place where she won't be interrupted)

This is because adrenaline is also an antidote to oxytocin. Any fear or anxiety will increase adrenaline, decreasing oxytocin and reducing contractions. This is where the stories of women in strong labour whose contractions slow or stop when they arrive at hospital come from.

Put simply, if you wouldn't make a baby somewhere, it is unlikely to be easy to birth one there without help unless you are protected, feel very safe and gently cared for.

You may be able to tell I am not a fan of syntocinon. It is generally a substitute for patience and good care - whether during labour or afterwards.

IMO it's use to stop heavy bleeding where it occurs post birth is it's only admirable quality Grin

CherryBlossom27 · 03/06/2012 08:15

I originally wanted the birth to be as natural as possible, and I was lucky and had a nice quick straightforward birth, but I got bored waiting for the placenta to come out naturally!

After about 45 minutes, I ask if I could have the injection and then it took about 5 minutes to come out! My midwife said they would give you an hour to deliver the placenta naturally before using the injection.

Next time, I will ask for the injection I think.

hufflepuffle · 03/06/2012 08:54

Thank you Bearhugs for all that very useful info. I have not discussed my birth plan with MW yet but I now feel much better informed. X
34, 21+1

OnlyWantsOneTwoAndThree · 03/06/2012 09:06

If you deliver baby in water - what is the advise for delivery of placenta?

Only im due with dc3 in 10 weeks and after a SVD in hospital (4 hrs active labour) then a 15 hour back to back failed home birth - transfer to hospital only to deliver within minutes Hmm I plan to have this one at local MLU with support of my amazing community MW and there is a pool there Grin

Bearhugs43 · 03/06/2012 14:06

In water you are usually asked to get out to await delivery of placenta because it has harder to judge blood loss in water (always looks more than it is because it gets diluted)

Your best option (based on the research) for mother and baby then is to

-wait for cord to finish pulsating

  • get baby skin to skin and to breast
  • deliver placenta with maternal effort before or after clamping cord (this usually just takes a few coughs or a gentle push)

If this takes longer than you or they would like, or there is heavier than normal bleeding then you can have syntocinon injection at any time once the cord is clamped.

HTH Smile

Bearhugs43 · 03/06/2012 14:33

hufflepuffle you are very welcome - anything else please ask Smile we are due the same time btw I am 20+5 x

Quip · 03/06/2012 14:40

The first time I did it naturally. It took a while, and was a bit of a faff that the placenta was hanging around for a bit, because after 6 hours of labour I felt like I could do with a rest.

The second time I also did it naturally, because I'm a tree hugger at heart, even though I work in an office and drink instant coffee. It was an even longer faff, the midwives told me to push it out but believe it or not I had forgotten how to push by that point. I lost quite a bit of blood but it didn't qualify as a haemorrhage (5ml less than the threshold apparently, not that anyone measured).

The third time I had the injection. My placenta was out before I noticed. I was amazed.

I think the important thing is, not just with the question of natural third stage vs injection, but with birth plans more generally, is that it's possible to focus so much attention and emotion to what you want that you can lose sight of the fact that in the grand scheme of bringing a child into the world, it's not a biggie. Just go with the flow and don't worry too much if the flow takes you in a different direction :)

Bearhugs43 · 03/06/2012 15:37

I do understand your points Quip but I also think it's very important we ad women understand our options in relation to protocols that are not in the best interests of the health of mother or baby and designed for convenience.

IME and IMHO I believe a bit of waiting or faff is worth it the benefit to the baby if receiving it's full blood volume.

Of course once this has happened if speed is desired or required then that's the time for a jab. Just not before required early clamping.

Each to their own to to what is best by them and their baby- but not just what is easiest for the system without full informed decision making Smile

AnnieLobeseder · 03/06/2012 15:42

With DD2 I wanted her to get the placental blood, so we delayed clamping until the cord had stopped pulsating (DD and I snuggled in this time, don't know how long it was). The MW told me it had stopped pulsating and asked me to push, which I did, and the placenta popped out. Easy peasy. I would have accepted the injection at that point if it hadn't come out though.

BellaOfTheBalls · 03/06/2012 15:45

I did a lot of research just before DS2's birth; I could not find a decent argument for or against natural delivery of the placenta. Everything I found seemed very much that it depended on the situation. With DS1 I was very tired, a little naive and asked for the injection. Eventually I decided that I would have a physiological third stage (i.e natural).

So hours of research, reading up, asking friends, posting on forums and...placenta wouldn't come. 2 lots of injection & 1 snapped umbilical cord later I found myself in theatre having surgery for a retained placenta. Angry

hufflepuffle · 04/06/2012 08:17

There you go Bearhugs ! Yes I am due 13th October! Hopefully catch you again here somewhere as time goes on! I am wondering what your background is to know this so well and explain so well? MW? Obstetrics? Or very well informed? Perhaps you would not want to say on here, no worries. I completely agree that it is important to be well informed about these choices. Yes, baby needs to come out, 1000s of people a day do it, and we need to trust medical staff to do the right thing. But if the standard procedure is there for convenience then it is certainly worth discussing. In my unit, the norm for a healthy birth is to send you home after 6 hours, even should this be the middle of night. I would like to think that baby has arrived with the chance of the best environment possible and optimum health. I hope my body is in the best shape possible for recovery and for breast feeding. Should interventions be needed I will not resist and will trust the advice but I feel it is very important to discuss with MWs what are ideal choices are. Thanks once again and best wishes. X