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 had a managed third stage with my first baby and natural third stage with my second and third children. (Last was an unintended free birth at home).
I found that I bled far less and for a shorter amount of time after the natural third stage births compared to the managed third stage of birth.
Placenta took around half hour each time to birth. No issues and no PPH.
I chose this as I really didn't see the requirement for syntocin as I didn't have a history of PPH, I was well cared for and monitored by midwives and didn't want medical treatment if not required.
The obstetrician post my sending birth was so revolting about me insisting on a natural stage three birth. I could hear him yelling at the midwives about 'women and their silly, uneducated ideas' and that he 'won't be responsible if she has a PPH'. His treatment of me both during labour and after I had birthed my child was the main reason I chose a home birth for my third baby.
The midwives has lots of questions each time as they rarely see a natural third stage. I also had to sign a medical waste form to take home my placenta after my second birth.

@Escapedtothecountry they must not be following guidelines then, at least not my trust, as I was that both times (2017 and now). Not sure what you meant by not all births are low risk? Both mine were classed as high risk with complex care plans.

@Colbinabbin

This is so interesting, thank you

Your experience bears out much of what hypnobirthing is trying to counteract in modern labour wards I think? (I take it you did study hypnobirthing?)

I do feel for the obstetricians, who only see problems that need fixing, and don’t know the benefits of educating a woman to have a quiet, private, patient environment in which to give birth. The obstetricians must always be thinking about the worse cases they have seen, and want to rush in to fix things.

I was so lucky to have my first in the MLU with quiet, gentle midwives. If any first time mums read this, I can’t stress enough how much hypnobirthing helped me. I am currently re-reading Maggie Howell’s ‘Natal Hypnotherapy’, it is excellent.

@TwinkleStars15 I’m so interested that you managed to have a home birth despite being advised not to? I am kind of in the same position myself.

Are you able to share any of the reasons why the doctors wanted you in hospital instead? Did you have to sign any kind of disclaimer?

Did the midwives support you in your choice in the run up to the big day? x

@Gerdticker I was classed as high risk due to the risk of a haemorrhage, as I’m on blood thinning injections. In my first pregnancy I wanted a home birth, but was talked out of it by the consultants who said that I was likely to have a massive bleed, need an blood transfusion, stay in hospital, be very unwell etc etc. What actually happened was a very relaxed and straightforward water birth, with a normal amount of bleeding and I was home 2 hours later. So this time round I was clear with them from the start that I would be having a home birth. No disclaimer was needed, they just wrote in my notes that I understood the “risks” but would be continuing with a home birth. I made sure that I did my research and was able to articulate myself in the appointments, ultimately they could see that I knew what I was talking about. Legally, you can birth your baby wherever you want to. They are not able to tell you that you can’t have a home birth, and despite people scaring you that no one will turn up, they absolutely will as they have a duty of care. I’m fact, I had 3 turn up initially! And that was when they were short staffed . They left when they established that I was “only 2cms” and he arrived a couple of hours later, just as another midwife was walking though the door! It was a beautiful, relaxed water birth, no complications at all and we all snuggled up on the sofa afterwards

Mine was a home birth after previous pph

To be honest I wished I hadn’t when I had the second pph (which basically happened because I wasn’t given the injection)

The birth was wonderful and the best it could have gone and wonderful for dd who was born in water in candlelight

But the pph later was really scary

The mw felt my first pph was due to clear factors in the first birth - poor positives baby so very long pushing stage, use of drip to speed up the labour so very long labour overall and very large baby. Risk of a second pph which was significant was assessed at 5% or less.

Second birth was textbook but I still had a big bleed

I’m a huge supporter of home birth and wanted a non managed third stage

But I do think it needs to be carefully thought through

I meant poorly positioned baby

@Onceuponatimethen

Thank you so so much for this. Real experiences are really helping me decide what to do.

I think you’ve just confirmed for me that I should definitely have the Syntocinon injection for a managed 3rd stage.

I had my 32 wk appointment a couple days ago and the Midwife said ‘you’d be bonkers not to have this baby in hospital’ which was quite a forthright opinion, but I appreciated her honesty!

I really hope that mentally I can stay in the zone to have a good water birth in hospital. Your home birth sounds incredible

I want to start a campaign so that all hospitals have MLU’s next door! They are so wonderful! Sadly at my trust the nearest MLU is 30 mins from hospital.

I had the injection with my first baby and nearly ended up in theatre, placenta would not come out and apparently they only have an hour to deliver it. They had me off the bed tugging on it it wasn’t nice.

Next three times I didn’t have the injection by choice took about half an hour for the placenta to come and it was fine, bleeding was less than the first too no big dinner plate clots.

I did not have a managed third stage, rejected the option of injection, in my opinion unless something is actually going wrong interference is not necessary and as likely to cause a problem that doesn't need to be.
Placenta delivered just fine. That was for both my DC, first was in midwife led unit and second at home. Neither put me under pressure to do it so I want made to feel bad/odd (Manchester area).

My friend who was in the North East was bullied into it (not that that is particularly relevant here) she bled massively which caused her all sorts of problems for quite a while after the birth and of course to this day she wishes she just let her body do what it was built to do as the point at which this injection was insisted upon there was no indications (such as delayed third stage) that intervention was necessary.
Personally I think less it's more when it comes to meddling in birth and any intervention decision should be led by necessity. But that's just my opinion.

It’s difficult with primary pphs because one can happen up to 24 hours after the birth

So, as with me, everything can seem fine and you say no to the injection.

I then had the pph a few hours later.

I refused syntometerin and had delay cord clamping.

I fortunately had a young, few years qualified, well informed midwife so she had no issues with this. I just told her to use her own discretion if things started going wrong, which they didn't, so all was well.

I think it is quite common to have a physiological third stage isn't it?
I had the injection with my first birth because the placenta hadn't delivered after an hour. Second time I didn't need it.