I have had problems with VEs since my PPH. They did manual removal and while I can cope with the absolute necessity of it at the time - I have still never felt so horribly violated in my entire life.

Do you think that if I mention this to my eventual MW that it might make it easier to express no means no without the guilt trips?
What - a manual removal without a GA??? How traumatic! I'm so very sorry for what you went through. I do wonder about what led up to the manual removal, I wonder if mis-managing or rushing the third stage led to the manual removal being necessary.

I recently heard of a birth (VBAC) in which they calmly waited for 7 hours before the placenta was gently born. (Obviously when a placenta is taking a while, you keep checking the mother's uterus, bladder and vital signs to make sure all is well).

This is definitely something to discuss with your midwife when you interview her. If she is a good independent midwife, it's likely that she would do VEs very rarely anyway. And discussing how you want third stage managed is vital. The right midwife for you is the one who understands how traumatic these events were for you, and will do all she can to avoid VEs or messing with a natural third stage.

There are some important things that are necessary to make third stage as safe as possible for a mother. It all comes back to how the birth hormones work. You need the things that will promote the optimal flow of oxytocin, so that the placenta will detach and the uterus will involute.

They are:
* naked baby placed on mother's bare chest, between her breasts, skin to skin.
* breast crawl - baby's kicking actually stimulates the uterus to involute. Baby's suckling stimuates the mother's pituitary to release oxytocin, which causes the uterus to involute
* quiet in the room - no loud voices
* privacy for mother, father and baby to bond, again, this enhances her hormonal flow
* the room should be warm. Cool temps inhibit the flow of oxytocin. Make sure if the mother moves to another room (such as the toilet), that that room is warm too.
* the lighting should be dim.
* mother's bladder should be empty or nearly empty

Arbitrary time limits can cause much mischief. Once, at a birth centre, the midwives were getting nervous and talking about the injection because an hour after the birth, there was still no placenta. I gave my client the heads up about the way the midwives were talking, and suggested they have a cuddle together, with her sitting on the toiler, with the lights off (she liked the dark, and had given birth in near total darkness.) 5 minutes later we had a placenta, and she just dodged the injection. Sometimes just some peace and quiet is all it takes - the natural birth hormones get a chance to do their thing.

Sometimes there is so much angst about getting the placenta out that it's counterproductive. If you 'reverse the energy' and stop focussing on getting the placenta born, and give the couple time to cuddle with their baby in quiet, warmth and darkness, it often all happens. This is assuming there are no signs of excessive bleeding.

Sometimes movement and gravity (such as getting out of the birth pool, or moving to sit on the toilet (with a basin in it to catch the placenta)) can be all it takes to get some action. Other times, patience and time are needed. You don't always get that in some institutions and this can create problems.

I've had two interesting placenta adventures at recent births. At one, the mama shut herself in her toilet, and firmly spoke to herself for about 10 minutes, telling herself that the birth was over and she could release her placenta now. She told her body to stop bleeding and release the placenta - and it did! She had had a traumatic birth the last time, so this was part of her overcoming those old fears and tensions.

At another birth, the mother had had a very traumatic c/s the last time, and her homebirth was a huge triumph over many emotional issues. She had pretty painful afterpains and was getting quite distressed. The pain kept taking her back to the trauma of the last birth, and she was feeling guilty that she was in too much pain to be bonding with her newborn. I had a little chat with her and her dh, and we actually prayed together. Then the midwife came in and was able to gently persuade her to roll over onto her back. That's all it took. A little bleed (which is a sign that the placenta is coming) - and out it came. The midwives had been bringing up the subject of transferring to hospital for a manual removal by this time! But more time, and extra reassurance, and a gentle approach, was all that was needed.

(I realise that there are times when synto and obstetric help ARE needed - but if these other techniques can be employed and more drastic measures avoided - that's good, right?)

Have you noticed that when the birth is pushed and rushed, it seems more likely that there will be PPH and placenta problems? An unhindered birth usually (not always, granted) yields a safe third stage, because the birth hormones that are flowing in an unhindered birth continue to provide for a safer third stage.