Choosing NOT to have managed 3rd stage?

[Gerdticker]

Has anyone here looked into it, and decided that they will decline a managed third stage? (So, NOT being given an Oxytocin injection after baby is born to speed up birth of the placenta)

I had a bad experience with Syntometrine after my first DC’s labour - I had a retained placenta and severe haemorrhage.

Most obstetricians seem to prefer women to have the oxytocin injection, but I have read a few articles and academic papers online that question if they are actually causing more retained placentas and haemorrhages?

Grateful for any thoughts on this x

I chose not to have it after my first, unfortunately my placenta didn’t deliver naturally, I haemorrhaged and had to have the injection (twice!) to get my placenta out. With my next baby they made a plan for me to have the injection, fluids through a drip and whatever they give you get your womb to contract. I bled anyway. 🤷‍♀️

So I guess whatever you plan it doesn’t always go how you went. My understanding is once you’ve haemorrhaged once you have a higher risk of it happening again.

I personally know of two cases where the mother had a natural labour then ended up in surgery for retained placentas after declining the injection. Obviously a small sample size and might not mean anything, but it was enough to make me accept the injection! I had no side effects from it aside from a spectacular vomit session.

I had a managed 3rd stage for my first birth, and threw up possibly due to the syntometrine. I declined it for subsequent ones.

The midwives were very supportive, to the point that when one placenta took longer than expected to come away and I said, 'I don't mind, I'll have the syntometrine', they said, 'No, no point if it makes you ill, shall we give it a few more minutes?' so we did.

In your shoes, I'd be sure to check that the bleeding you suffered always due to the syntometrine as it's meant to stop that happening. When I gave birth at home I was happy to know that syntometrine was available, just in case.

I didn’t have the injection after a Pph first time round when I did have it.

In my second birth (no injection) there was no bleeding at the time and then hours later (still within 24 hrs of the birth) I had a pph at home.

I would always have the injection now

Made me massively vomit too. Was fun.

I had the injection first time after a very quick delivery (stage 2 - 18 minutes) and it left me feeling awful - it was very quick and I fainted. Part of the placenta was retained and I had a nasty infection by the time the midwives came out to check on me several days later which needed antibiotics and I was told those antibiotics weren't compatible with breast feeding by the oh so helpful hospital pharmacist.

Second time I didn't have the injection, and it was much more straightforward, DS and I had time for a cuddle before the placenta was delivered so I had a little break between labour and end of stage 3 which I really needed.

The paramedics who delivered DS2 were desperately looking up drug protocols and were actually quite happy when I suggested a natural third stage. They could have administered it, but preferred (in the absence of a midwife) only to do it if the mother was hemorrhaging and so desperately needed it.

I'm 38+3 with first baby so no prior experience. Am planning for physiological 3rd stage, and all the midwives who've asked / read that in my notes have been pleased to the point of excited that someone's daring to try and do it without the drug ... tbh it baffled me why they were so enthused, but it's certainly helped me feel confident and relaxed about my choice. It's something the body knows naturally how to do. I'm well aware the birth plan doesn't always go as hoped and if I need the injection after a while I can ask for it then.

One MW said to me - give it until the baby's had 5 sucks on the breast.

Dont know if that helps you at all x

I was happy to have the Synto after my birth but I gave birth drug-free in a midwife led unit, so they were a bit against giving it to me in case it made me sick. However, my placenta didn’t come out by itself so I ended up having the injection anyway and had no sickness or side effects whatsoever (except the contraction pains you get). So personally I would choose to get the Synto next time. However, if you feel it hasn’t helped from previous experiences you can certainly say no. I had my injection after at least 10 minutes after having her so could always wait a little bit and see!

I declined the injection and the placenta came away no issues at all within ten minutes of delivering my daughter.
I remember noting the shock at the time from the midwives when they went to read my notes and it said no managed third stage.
I didn't know it was such a big deal to be honest. I wasn't fussed either way, just at the time I said no, I didn't look into the reasons why.
Currently pregnant again and would happily do the same next time.

I had a physiological third stage with my first baby (homebirth), no issues at all, placenta came on its own 20 minutes after baby. Normal blood loss. I’m pregnant with second baby and planning the same (due any day!)

It’s completely your choice at the end of the day.

I chose not to for all three births. Not keen on routine interventions. Brilliant tip my midwife used is to blow into a beer bottle and this triggers the expulsion of the placenta. Worked like magic on my third birth where placenta was slow.

I didn't have the injection for my last 2 (home births). All went well, no issues I can remember.

Psyliological third stage with all three. No issues. Supportive midwives.

Physiological...

Your choice definitely.
However take care with the academic papers you read - it’s definitely shown to reduce bleeding, and generally if you had a PPH last time that’s even more reason to manage things actively this time. Worth talking through a detailed plan with your midwife though.
Confusion sometimes comes when you compare the amount of oxytocin/other drugs given to a woman who has had a PPH, vs to a woman who hasn’t - obviously you find way more drugs are given in the setting of PPH but comparing the two is not valid - you need to look at studies that compare in a randomized way, and “intention to treat” - ie it’s decided before delivery whether they’re having injection or not, and then outcomes are compared, rather than doing it backwards if that makes sense!

The other thing to mention (for PPs, not sure if this applies to you) is that syntometrine generally causes vomiting and syntocinon or oxytocin doesn’t. (Syntometrine is a combo of oxytocin/syntocinon and ergometrine). Both drugs work basically the same, some units have a protocol for one or the other but you can definitely just request the oxytocin part to try avoid the vomiting.

You’ll find obstetricians prefer active management because it’s obstetricians that have to manage the fallout of a bad PPH, not the midwives. However (I seem to say this a lot) it’s all about how you look at your own level of risk, and your own priorities - just make sure you’re using good information for your decisions.

Hope all goes much better for you this time either way :)

I didn’t even notice the injection, or placenta being delivered tbh. I was of the opinion that whatever worked was fine by me.

@TenThousandSpoons0

Thanks so much for this balanced assessment.

Yes I was given Syntometrine at an MLU, and recently an Obstetrician at my local hospital told me they now prefer Syntocinon as their first line drug. He said it works in a ‘lighter’ way but I didn’t manage to pin down exactly what that meant!

I think it looks like I will have the syntocinon after all.

I’ve had two births, one with the injection and one without. The one without wasn’t an active decision, it just came away about 5-10 minutes after I delivered him - I was still in the pool. No obvious difference in bleeding for me; although I’m only 24 hours post birth, so far everything is fine.

Ah congrats @TwinkleStars15 !!

How was your second labour compared to first time round? I managed to have my first in the pool, so really hoping it works out that way this time too x

@Gerdticker I had a home birth this time. It was against medical advice but not advise that I agreed with. It was absolutely perfect; I had him in the pool with my 3 year old present. Labours we’re actually very similar - first was 7 hours, second was 9 hours, but both times I was examined after 5 hours of contractions only to be told I was “only 2cms” but then they arrive within the next hour or two! I have absolutely no faith in vaginal examinations after my two labours, there is no hard and fast rule about how quickly you should dilate but they still use the rule of 1cm an hour. It’s daft.

@TwinkleStars15 I'm laughing but I would agree with you on the vaginal examine and estimations. My third baby I woke up at 3:30am contracting strongly -just out of no where seemingly, but when I arrived at the hospital at 4am I was 7cm so must have been contracting either in my sleep or I did 7cm in 30 mins. Whatever, he was out pretty fast. They come when they want to as they say.

The ergometrine element of syntometrine causes a contraction that is of rapid onset but short lasting. The oxytocin element of the syntometrine is slower to take effect but sustains the contraction for a longer period.

iirc,
Birth 1: had jab as baby was born -> hurt a lot & huge bruise afterwards.
Birth 2: no jab, no problems
Birth 3: delayed placenta and small pph so things were already feeling pear-shaped, finally had jab after 45 minutes, placenta came out fine after that
Birth 4: no jab, no problems (not even pph)

"they still use the rule of 1cm an hour, its daft." No, "they " don't. Not if following NICE guidelines. There has to be evidence based guidelines to follow to prevent major complications. Not all labours are low risk