3rd Stage Questions

I am having my second child in a few weeks and am just getting my birth plan organised.

With my first I had a managed 3rd stage that ended with a retained placenta and PPH blood loss of 900ml or so. While still in delivery suite the Dr. stitched up my anterior tear, episiotomy and the 3 bleeders in my uterus. Then as my placenta refused to come I was whisked off to operating theatre for manual removal of the placenta. With the ultimate threat of a hysterectomy if they couldn't stop the bleeding. (I refuse blood transfusions.) Everthing went well except I am very hard intubate (I now know this) and the dr. undid all her hard work of stitches in the process of removing the placenta and had to redo them. Anyhow placenta was ragged... what does this indicate. And I have read that one indication of manual removal is the cervix closing up to early from the syntocin. Does it sound like this happened? It doesn't to me as it sounds like the placenta was just stuck to me like glue especially if removal resulted in tearing those stitches.

I talked to my GP as I am shared care. He said to me that statistic wise there are two facts that improve mortality etc in obstetrics... one prenatal care and the other is syntocin in 3rd stage to help with PPH.

But as I read in another thread, posting from Alan that it shouldn't just be given as a preventative but in response to appropriate indications. I know they want a canula in me from the beginning. I don't want it but It's not something I am going to argue with. I guess my biggest concern is that one the syntocin will close up my cervix too soon, and two that because they are hypersensitive to my previous retained placenta that they will not give me any time at all and just take me to operating theatre. I don't want to be whisked off without giving my body a chance to do what it's supposed to but because of my added 'risk' of not accepting blood transfusions I have to let them do what they need to if I am bleeding. So considering all this should I specify that I only want syntocin if I am bleeding, or should I have it regardless because I had it with the last one.

On a side thought, I have managed pre-existing essential hypertension (both pregnancies) with number one I learned that the biggest risk with unmanaged high BP in pregnancy is placental abruption, so I find it ironic my placenta wouldn't come away! Maybe it was too much bio-feedback LOL!

hi there

I'm not an expert but all pregnancies are different so perhaps you should just go with the flow. As the doctors are all aware of the difficulties you had with your first pregnancy, then they should be pretty much in tune with your wishes.

Hi Mariahswind

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Anyhow placenta was ragged... what does this indicate

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Usually we would say that the placenta is incomplete or the membranes are ragged. In either case it could mean that a small part of the placenta or the membranes have been left behind in your uterus and potentially cause an infection. In your case this could have happened during manual removal.
Syntocinon is used to help prevent/stop bleeding. It works by causing your uterus to shrink. It also causes your cervix to close. One of the possible side effects of this is that your cervix closes prior to your placenta being birthed and thus trapping it inside your uterus. Syntocinon works quite quickly when injected into a muscle but it works very quickly when injected directly in to a vein. So for you I would recommend that you do have the cannula inserted prior to birth.
Another drug that can be used instead of syntocinon is ergometrine. This drug is more powerful than syntocinon but it also has more side effects. There is also a mixture of the two called syntonetrine.
No one can tell you which way to go, you need to do your research and decide for yourself. Hopefully this information will help with that decision.