Active third stage over natural third stage.

I just got back from seeing my Doctor at the hospital, im 39 weeks. He was actually really great and helpfull and talked to me loads, whichi was happy about.

We were talking about the fact that id had quite a big bleed after my last birth, and that i would be required to have a canular in as soon as i got to the hospital, shich i knew anyway, that was fine, he agreed that i could have the canular in my arm rather than my hand as i requested...all good....then he wrote on my note that i would have to have an active third stage, i asked what that ment and he told me i would have the syntosinin injection as the babies shoulders are born to avoid another bleed..... thing i didnt get was my bleed was due to a cervical tear nothing to do with my uterus contracting....he proceeded to inform me that the risk of PPH was alot greater the second time around and my body wouldnt deal with it as well the second time around as it did the first time.

So should i just accept the fact that an active third stage is required and safer....i really want to avoid a bleed so i can leave hospital ASAP after the birth and as it really affected DH last time. Or should i push for a natural third stage, breastfeeding etc, giving my body chance to do its thing. CONFUSED......:rolleyes:

Hmm I don't know anything about cervix tears. So it's likely your cervix will tear again? I guess if you know what you're up against you can assess it.
Hopefully someone in your position will come in & give you some advice soon hun :) good luck.

i dont really see why it would tear again....my GP explained to me that due to the epidural i had last time my labour was slowed and extra strain was put on all the inside bits ( IYKWIM ) and that could easily have casued the cervix to tear....but the doc sort of shugged and said 'i guess' when i asked him about that today. He said not having an epidural would lessen my chances 'slightly'(which in my eyes is great) but the syntosinin would still be needed.... i dont know!

Beckoes - it is really hard isn't it, I had a PPH with #1 and was petrified it would happen again.
I am not sure why/how I haemorrhaged but regardless the hossy's policy was to put a cannular in - The MW's were unable to put the cannular in my hand when I was in labour, DD2 was post and I couldn't stay still for long enough.
They then proceeded to wait and assess before administering any injection - so I was able to avoid it. I got the feeling they were perhaps *supposed* to have given it to me but were more comfortable to wait and see if it was required. My delivery was so different to number 1 that I virtually danced around the birthing suite straight away!
Is there any chance of asking your Obs the probability of it happening and seeing if they are happy to be on standby if it is safe to do so??

SO its not a given that just casue you had a bleed the first time that it will happen the next time?the doc sort of made out that it WOULD happen!?

Id rather do that, be ready and if its needed, have it, but its in my notes now so i dont know if il be able to avoid it!?

Thanks

i had a secondary PPH with DS and lost 1800ml and required two transfusions and had to be rushed to theatre so with the birth of DD my midwife explained i would need the cannula in before she was born and that it was much safer to have the injection for third stage. They would only then hook the drip up to the cannula if it looked like i was bleeding too much. I was glad they had a plan as i did not want to go through what i went through last time and neither did my DH as it was really distressing for him.
This time round i had a primary PPH and lost 700ml but didn't require a transfusion, i think the reason it wasn't as much as last time was because they got the drip going quite quickly and having the cannula already in place saved some time.
THis is just my story but hope it helps you. Good luck :)

Check out the forum 'Third and Fourth Stage of Labour' as it discusses this in great detail in several threads.

thanks kimmy, im thinking that it might just be better to be on the safe side!!

thanks kelly, il check it out!

I asked my OB this when I was pregnant with DD - he said "well if you have the shot you have a lower chance of having a PPH (he quoted me a figure but I can't remember it now) and if you don't have the shot and have a PPH you will need a lot more than the shot" by which I assumed he meant a synto drip which they used to stop the bleeding.
In any case, I had the shot, still had a bleed and needed the drip so I'm absolutely no use! Maybe have a google around for PPH you might find some useful figures on it.

You're at lower chance of PPH if you don't get induced or have a c/s!!! But they don't go promoting that... for some strange reason... *scratches head*

That doesn't really make sense. I'd understand if it was due to your uterus failing to contract enough, but not the tearing...
After losing 2.6l last time, our midwife said I'd probabl have to have a cannula put in and managed 3rd stage for next time. I'm not certain how much more likel it is to happen if it's happened before, but she did note that if it had been a tear or cut causing the PPH then it would n't be an issue.

I had a small haemorrhage last time, and this time I've had to sign a waiver saying I understand that not having the injection is against hospital policy. I did tear just a bit with T, so the haemorrhage could quite easily have been from that (according to the midwife). They'll monitor me and I'm happy with that. I'm also interested in NOT tearing this time :D so hopefully it won't be an issue!

I've got loads of confidence that I'm not going to, you know, bleed to death or anything. But it seems that having the injection is the recommended option 'these days' ... opinions and recommendations seem to change so quickly. Good luck with making your choice.

I am not sure what kind of PPH I had...but I was induced and I am pretty sure that is why the MW's were happy to watch and wait, they seemed pretty confident it would all be ok and knew my history really well as I had GD and monitoring every second day as I wanted to avoid induction a second time.

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So should i just accept the fact that an active third stage is required and safer....i really want to avoid a bleed so i can leave hospital ASAP after the birth and as it really affected DH last time. Or should i push for a natural third stage, breastfeeding etc, giving my body chance to do its thing. CONFUSED......:rolleyes:

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Even if you have an active third stage, this won't stop you having skin to skin straight away and letting bub breastfeed as soon as they are ready.

Hi Beckos, where are you having bub? I birthed the placenta naturally which my OB was happy to let me do however we did leave this one 'open' to see what happened on the day. If there was loads of bleeding and my
OB didn't want to risk more blood loss and a blood transfusion being a possible outcome than I'd just have the injection, you can still breastfeed and do everything else like you normally would. Luckily for me everything was fast and drug free and ran smoothly as I birthed DS in the water but if I ended up needing it I would have gotten it. Maybe you could put something like that on your birth plan "only give me syntosinin if there is excess bleeding" There is no need to say yes or no to it before you know what is actually happening kwim. We also left the Vit K injection up to 'we'll see what happens on the day' if the birth was rough and bub had a hard time of it too with assistance and was bruised etc we were going to give it to him but as the birth was so smooth we declined it. If you are also wanting to do delayed claming than having the syntosinin shouldn't interfere with that either.

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There are some circumstances where the cord will need to be clamped immediately, including if you choose to have the third stage injection of syntocinon to expel the placenta faster – obviously the cord will need to be cut right away in this managed form of third stage. You can chose a normal physiological third stage if you haven’t had syntocinon during your labour (for inductions, augmentations or third stage).

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I just found this in an article on BB. so if i have a managed third stage then i cant delay cord clamping!!!! not happy jan, this is something i think is quite important, allowing the baby to get the blood from the placenta. so i think i will insist on waiting till after the baby is born and atleast wait 2/3 minutes to allow enough of the blood to get to baby before having the injection, if it is needed atall....

*off to edit my birth preferences*

Thanks for all your replies!

beckoes I believe that information is incorrect. We only had DS 5 months ago at Selangor and I can assure you that we were doing delayed cord clamping with or without the injection. We discussed it at length with our OB too and it was very clear that was what we wanted and it was on our birth plan and his paperwork for the hospital. We were only going to have the injection for the placenta if the birth didn't go smoothly and if there was excess bleeding and it looked like there would be problems but even then it was very clear that the clamping be delayed. It only takes a few minutes for the cord to stop pulsing anyway and there is plenty of time to birth the placenta with our without the injection and still delay the clamping. Check this out with your OB and as I said you don't need to decide before hand what you'll do for sure, there are some things you can leave until the day and make a decision based on what kind of birth you have. Can't wait to read your BA and good luck with everything :D

I am interested to know if you can delay clamping with the synto injection, this was something I had down to discuss with my ob at my next appointment. I just did a google search and there didn't seem to be any definite information. Some suggestions that the synto goes to baby... but if that is the case wouldn't they already get the oxytocin from you? How would sythetic oxytocin hurt them? You can also delay the injection until the cord has stopped pulsing which doesn't actually take very long from what I have read, it doesn't HAVE to be given as the shoulders are birthed (obviously, since it doesn't HAVE to be given at all ;)).

I had the injection with DS2 and still breastfed straight away. I didn't notice the injection, and if you can still delay clamping, which I would like to do this time around, then I will have the injection again. Especially if I tear badly again... I don't want to be waiting too long for them to be able to stitch me back up.

I understood they had to clamp straight away if the injection is given... I think maybe something to do with overpumping through the cord.... Could be wrong about that.
Our midwife suggested it might be possible to delay clamping, then give the shot (as a sort of compromise)