confused (and a little bit of a vent)

So I had my 37 week appt with my GP Ob today and went through my birth plan with him. He was ok with the delayed clamping but got funny about me not wanting the injection and said he didn't think the MWs would be comfortable with that (even though I told him the one running the antenatal class didn't seem perturbed).

He asked me why I didn't want it and I said that if I could get the same hormone naturally by bfing then why do I need it. And that I also did not want the drug going through the cord before it was clamped/cut. He told me I was reading too much into it and that it helped stopped bleeding. When I said that I understood that women were still at risk of PPH with the injection and asked what the increased risk of not having the injection was, he said the risks are different for everyone. He went on to say that its not an uncommon thing to lose blood and if you lose a lot (like 3L) questions will be asked about why the injection wasn't given. And if it was part of the birth plan they "might go easier" on the MW. (So am I getting the MW in trouble now??) So I asked him if he had many patients not have the injection and he said no. I said can't I get the injection if I start bleeding and he said it takes a while to work which is why its ok to have delayed cord clamping because it doesn't go straight into the system. So I was getting upset (as of course a heavily pg woman is prone to do) and didn't want to start getting hysterical. So I left it at that and he said to think about it. (He even told me to talk to my sis who had a bub 4 months ago at the same hospital, I think he thought that would make me think "what am I making a fuss about??)

So now I'm confused. He's been an ob for many many years (my mum actually was under his care for my sister) plus he's an anaethetist so you'd think he'd know how these drugs work. My thoughts/questions are:
- if bleeds are common, but no one he treats opts to NOT have the injection, then they have had the injection and still bleed so how is it any more beneficial to have it?;
- if the MW aren't open/trained for physiological, is it riskier?;
- how long does it take to work? so if I declined the injection then started bleeding could the injection be given and expel the placenta quickly?

My DH has said he wants me to have it because he doesn't want anything to happen to me (I think he thinks I'll bleed to death). This is after today's appt (he wasn't there, just what I said the dr said). I totally understand that things don't always go to plan, but in the perfect scenario why can't I do it on my own???

Ok Melly, I have had 6 kids and never had the single shot needle.

Angel was Phys 3rd stage, all good.
Chill was Phys 3rd stage, all good.

Princess was not done properly. They took her off me, swaddled her up and then let half the family into the room. I could not feed my baby, I could not go to the toilet, there was a sheet between my DD1 and DS1 and a sight they did not need to see. I bled. >3L PPH. It was not a rapid bleed, I might point Glamourcide in here to cover that part for you. Anyway in a real PPH situation, they don't bother with the needle, you get the drip. The needle is too small a dose to properly control a PPH.

Tsunami and Hurricane were both managed to the extreme with canula and synto drip. That is because of what happened with Princess. I was an increased risk of PPH.

They wanted to do the same with Diva because I am an increased risk for PPH. I have the prior PPH risk factor and Grand Multi.
I got my phys 3rd stage with Diva. No PPH.

The second most important thing you can do for a Phys 3rd stage is tinkle.

As for the Oxytocin taking a while to work.. That is a new one on me. It is a fast acting hormone. It is also short lived so you are better off getting it when you need it. There was a study that compared giving oxytocin at the birth of the shoulders against after delivery of the placenta. They had more success in lowering blood loss and preventing PPH in the group that were administered oxytocin after the placenta was delivered.

Feed your baby, empty your bladder, snuggle as much as possible. Phys third stages are perfectly achievable, even with a history like mine.

he is giving you the run around.

hmmm, sorry if i'm a bit clueless, but are you talking about the needle they give after you had baby that gets the placenta out quicker?? if you are, that's not something you *have* to have. it is something they like to give, but you can choose not to have it. in fact, *Efjay* had her bub on monday, and she wasn't given the injection, her placenta came out after about 45 minutes i think? maybe PM her and see what she says. (and she didn't bleed to death cause she didn't have it Lol) also, being an OB, they also tend to go on about risks :rolleyes: which i know some are obviously important and valid, but legally i think they have to say them to you anyway....sorry i can't help more, but good luck!! ;)

It's not something you have to have, however if your 'care providers' give it every time you will have to fight to not have it. And sometimes they will just give it anyway, despite your refusal. Unfortunately, assaults happen everyday in the maternity ward and you may have to fight and keep fighting if this is something you don't want to have.

My experience...

DD I had the shot, cuz I just went with it, didn't really mind either way.

DS I wanted delayed cord clamping and also the phys 3rd stage and as I was at a birth centre, with MWs, they actually offered it before I asked anyway! Score.

But then - I birthed DS on one knee, they passed him up through my legs so I could hold him, and helped me up onto a birthing stool so I could birth the placenta. At this point it was me, DH, the main MW, a student and a paed reg as I had meconium in my waters. The reg basically stood in the background until...

When I got up onto the stool, I felt a big gushing flow of liquid and saw the MW and student exchange a glance, the reg stepped forward and I said "is that blood?" my DH went a little pale and said yes - the MWs took DS and gave him to the Reg so he could check him over (he had to anyway due to the meconium) and the MWs put me up on the bed to try and control the bleeding. Within about a minute I reckon they had given me the shot, the bleeding slowed, DS was fine and placed straight back on my chest at my breast to start the natural hormone flowing.

It wasn't a PPH but it was enough to worry them and the point I'm trying to make is that it can happen really quickly when it needs to and as one of the PPs has pointed out, it is a fast acting injection.

If you want the phys 3rd stage, push for it. You do not have to consent to the jab if you don't want it.

thanks so much ladies. It has eased my mind a lot. I understand he has to talk about risk etc but why he said it takes time to work when it doesn't I don't know. Now to get DH back on board.

thanks again!

I have never had the syntocinon injection to deliver the placenta...I have always delivered it within 10-15min after birth.
I have been fortunate a not to have a PPH but I have bleed more with each birth.
As the others have said it is not something you have to have and if you don't want it stand your ground.

as a PP mentioned he is giving you the run around. you have every right to not have the injection and this should be followed in your birth plan. but as HotI mentioned you will need DH (or yourself) to make this very clear in teh birth room and to keep a good eye out as sometimes they can give it to you without you even realising. I recommend that when you pack your birth plan in your hossy bag that you have any wishes such as this written in bold red writing. my midwives advised this as the attending staff find it easier to read highlighted important bits :)

i had a physiological 3rd stage with DD2 and the placenta took 45 minutes to come down.

Holistic physiological care compared with active management of the third stage of labour for women at low risk of postpartum haemorrhage: A cohort study

Elsevier

:p

I didn't have the shot with my last one but i had written on my birth plan that if after about 1/2 an hour i hadn't delivered the placenta that i would be willing to consider the shot if they had any concerns.I was fortunate to be in a midwife care program & after about 20 mins-1/2 an hour i delivered the placenta naturally sitting in the same spot on the floor where i had delivered my son.I think saying that i was willing to reconsider after a certain time period if nescessary made them feel a bit more relaxed about going along with my wishes.Good luck with getting the birth that you want:)