Managed 3rd stage - No option for me

Hi Ladies,

My last birth resulted in a retained placenta that needed to be manually removed. I started to do some research regarding managed 3rd stage versus natural.

When I went to my mid apt I mentioned the possibility of a natural 3rd stage with delayed cord clamping and I was quickly told not possible for me. Then they went onto explain that I would need to have an iv inserted as soon as I arrive to hospital.

The thought of labouring with one of those things in my hand is horrible. They are so painful. Do I really need to have this done? or can I refuse?

ofcourse u can refuse. Its your body and your baby. Before u do.. ask them WHY u NEED to have it. Like the pro's and con's. HTH

Bek, I would be asking firstly why you need it, and then if there are any alternatives. Make them explain it to you. It may be that there aren't any alternatives, that it is the safest thing for you - but at least if you understand why you need it, you will feel better about having it.

Hmmm I thought most hospitals only demanded a canula before birth if you had had a previous PPH - you didnt mention you did, so I will assume you didnt! If so, that could be the reason.

However it might well be their policy that if you have had probs with placenta retention you must have shot after birth.

you can refuse managed 3rd stage and will have to sign a waiver. Also you DONT have to have a canula. They do that incase they need to give you something and it makes their lives easier, but in the crossfire it makes labouring worse. I hated the canula I had in my hand but I had an induction.
Tell them to go jump if you like ;)

I had this with my last birth - was told beforehand that they wanted me to have a cannula put in when I go into the hospital, as a 'just in case' thing, because I had previous PPH. TBH it didn't bother me - the midwive did a great job putting it in, it hardly hurt and I barely noticed it was there. BUT in the end I didn't need it - no PPH (which I firmly believe now was due to the fact that I was not put on a synto drip - the induction drug increases your chances of PPH).

Anyway, no you don't have to have it put in - but be prepared to be firm about it, because they will most definitely be against the idea, and put it in writing or sign a waiver or whatever so that they have it documented that you refused.

I am pretty sure Sam (raven) had a previous retained placenta and had a physiological third stage, no placenta issues. There is no such thing as no choice. Just like Jahovahs (sorry spelling) Witnesses refuse blood transfusions... they are granted that based on religion but birth and its a lockdown.

The midwife explained that they use 2 different types of drugs to help expel the placenta. I can't remember the correct names but they sound similar. This first is the injection at birth and the second is administered via iv if the first doesn't work.

Because I have had a rp they'll skip the first and administer the second straight up. This is insure my uterus contracts sufficently to expel the placenta. They want to prevent possible PPH.

At the same time the mid told me that neither of these drugs work if my placenta will need to be removed manually. This is what happened last time!!! So if the placenta is going to get stuck then it will be stuck and there is not point to administering the second drug.

I absolutely hate canulas and I feel that my birthing experience will be more uncomfortable than required. I would prefer to labour without a canula and see what happens. I will be pushing the point

I can empathise. I am on the rough road of asking for a Phys third stage. I have had a previous PPH - but there were circumstances that raised my risk factor (long labour that was intefered with on a regular basis!!). I still have a raised risk factor with the history of PPH and Grand Multiparity, but I do feel that my body will be better off for the hands off labour that I am aiming for.

I am agreeing to the canula though as it can be harder to put in when things have already gone wrong. It is evil to get it put in and you need to make sure they don't stick it near the wrist because that is the absolute worst place to have it, and ask for the small one because you don't even notice it. But you can refuse it, yes. They will probably feel better with the canula though and I find a little bit of give helps them give a bit back without getting uptight and treating me like a difficult patient.

Also, early clamping can cause a litany of issues - including blood clotting around the placenta which can lead to PPH! Cord Traction too can cause a whole bunch of issues like incomplete placenta and introverted uterus. Yes, I just spent weeks reading all this to make sure I was making the best decision despite my risk factor. I feel that asking for the third stage to be hands off is giving my body the best chance to NOT pph, rather than trying to prevent it from happening when you have done everything possible to practically ask for it. I'd definitely recommend doing all the reading I have, because it is really does make it best for you to decide if you want to go the distance with an unwilling hospital.

I had three manual removals for retained placentas - my second involving a very significant PPH. For my third I asked for a natural 3rd stage and was told the same as yourself - only to have the cord snap off with the tugging, hands up my hoo-har and end up in surgery anyway.

My 4th was an induction, but I managed to occlude the drip during 2nd stage so it was useless anyways, I ended up with a natural 3rd stage which suprised the hell out of me - no cord clamping, breastfeeding and boom, out comes a placenta about 20 minutes later. I had been told that it would never happen for me, that my uterus was probably scarred from all the manual removals and such, but it wasn't.

I firmly believe that the managed 3rd stage CAUSED my retained placentas, my body needed to do it my way, not be rushed into it.

I dont' know why they think they need to rip the placenta out of there within seconds of birth. It can take over half an hour sometimes. Do they think that the placenta is going to weld itself to the uterine wall if they don't grab it out in the same contraction as the baby comes out? If it's going to stick, it's going to do so 30 seconds or 30 minutes after the birth. They have time to wait. Only if you start haemorraging does it become an emergency situation.

How long do they think it takes to put a canula in? It takes a doctor 30 seconds - why do you need to labour with it in? After half an hour, if the placenta isn't budging, then they can take the half a minute to put it in before giving you the drugs can't they? I mean, think about it, how long after you were determined to have a retained placenta last time did you get to theatre for a manual removal? Half an hour? Don't think there's time to pop in a drip in that time eh? Even on the time I was bleeding out, it was still over half an hour between first gush and anaesthetic.

In my last birth, I requested no managed 3rd stage at all, even in the event of a retained placenta. If I had a placenta still stuck in my after a prolonged time, I was to be taken straight to theatre. I find that the trauma I have suffered through my managed 3rd stages was far more significant than the trip to theatre to knock me out. I did ask in my 3rd birth not to have any pulling, pushing or tugging at all, but the doctor just had to give it one go apparently, and said cord snapped, and then just just wanted to grab it, so I ended up with two hands up my bits at the same time. Talk about painful and undignified. I was begging to be taken straight to theatre instead, but nobody listened to the birthing woman grrrrr.

HTH a little :)

Do whats best for you. I had a manual removal of retained placenta with no 1. Later as a midwife I learnt that it was retained as I had such a long labour. I had being having regular painful contractions for 2days (48hrs) before the hospital would admit me saying I was not dilated enough. I was 7cm when I was admitted finally to the labour ward and still did not birth for 10hrs later which included almost 3hrs of pushing (posterior baby) and because she was not distressed they were happy for me to keep pushing until she showed signs she had had enough. Well I did birth her eventually all on my own surprisingly being OP. Well the placenta didn't come out then. I have now learnt as a midwife that because my labour and birth was so long my uterus was exhausted and as soon as bubba was out it thought its job was done. Despite all the drugs under the sun nothing was making my uterus contract. After 4hrs and bleeding profusely off to OT I went. (I now work at the same hospital and 1hr is the policy to wait for placenta to be expelled before OT) Also 2hrs is the limit for pushing in the second stage (what happened to me I ask?) Well with number 2 as I went to OT and had a PPH (because the placenta wasn't out and no contractions to decrease the size of the uterus) with no 2 I was hit with a IVC (cannula) and all the drugs as soon as bubba came out. Placenta came out within a minute or two with limited cord traction. No problems and I felt great was able to shower on my own and walk to the postnatal ward much nicer then the first time when I couldn't shower for 24hrs later (eewww). Our hospital policy is literally IVC as soon as you walk in the door with a history of retained placenta or PPH. So maybe you should find out why it happened if you know! One time is not enough to say you have a strong history. I know with my second baby the placenta had several succtenturiate lobes which are like little placentas stuck to the main placenta. I wonder if that happened with the first baby and thats why it didnt want to come out. GL do what you want and if it wont come out you can always switch to the IVC after your baby is born and then have the drugs.

Have you had any trouble in having cannulas/blood taken in the past? If you have 'good' veins, this will give you another argument for why it won't be an issue to place it later if it is needed.

River - DD's cord was very short apparently and when cut it went back inside me. They then wnet fishing for it and gave it a good few tugs to help the placenta release. Then the ob was called and he attacked my insides with a hook until the I was lifting off the bed in pain the middy told him to stop....Then I was hooked up to the IV and they waited 1 hour post birth but absolutely no contractions to help move the placenta. You worded my thoughts regarding the need for a cannual straight up very well. My question is why should I put one in if I have time? I mean they put one in after the fact with DD so what would be different.

Emmy - My labour was fast 3 hours from first contraction to birth. When I got to hossy I was 6cm and 20mins later I was 8cm. The middy broke my waters because she wanted the baby born before breakfast!!! At the time I thought yeah a quicker labour, lets get this over with. But the minute she broke my waters the pain was unbearable and bub was born in 5mins..much to the shock of the midwife and me. I felt that my body was in shock to some extent.

Another reason why I may have had a RP was that dd was conceive 2 wks after a DandC so maybe my uterus was a bit raw and the placenta attached itself really well. Thanks for your input