Third Stage of Labour - Naturally?

At our antenatel classes last week we covered the stages of labour. The midwife mentioned the injection to deliver the placenta quickly and I asked her if delivering it naturally was an option. She said that it was 'standard hospital procedure' but to check with my OB. She mentioned the chances of postpartum haemorrhage was high without the injection. I am now looking further into this and just read the article on the BB site: 'Leaving Well Alone: A Natural Approach to the Third Stage of Labour' By Dr Sarah Buckley.

The following is from the article (hope I am allowed to quote from it):

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Cord blood harvesting, which is currently being promoted to fill Cord Blood Banks for future treatment of children with leukaemia, involves immediate clamping, and up to 100 ml of this extraordinary blood can be taken from the baby to whom it belongs. Perhaps this is justifiable where active management is practiced, and the blood would be otherwise discarded, but, unfortunately, cord blood donation is incompatible with a physiological (natural) third stage.

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We are planning to donate our babies cord blood but now I am wondering if I can if I choose a natural third stage.

Can anyone give me their personal experience or knowledge on this as I would like to be clear before I go into labour. BTW I am hoping for a drug free labour and do not want an epidural or pethadine but am considering gas as a last resort, and this is why I am looking into a complete natural birth if it is possible.

I never had an injection to deliver the placenta's from my two labours. They were both delivered naturally.

Love

Hey Gemma,
We too are facing this dilema but if you want a natural third stage you cant donate the cord blood because apparently it needs to be clamped immediately and taken before it stops pulsating. We are still unsure as to what we are going to do. I would be interested to know what you are going to do.

Hi Gemma.
Just in case you missed this I thought I'd post a link as it may have some things you might find interesting to read!

here

I will ask for a natural third stage of labour for my next bub now. I've been thinking this over for a few weeks now.

Yup Shannons right. I did a natural third stage at home. I left Tehay attached to the cord for around 30 - 40 minutes til the cord stopped pulsing, i figure it's her blood, why shouldn't she have it all.


Take care
Trish

Kathryn, are you sure you didn't have the injection?
The only reason I ask is that I was told it's standard procedure according to AMA medical guidelines unless specifically requested not to be administered by the mother. I didn't realise I'd had the injection with either of my kids until I was told afterwards with Sean, and with Kate I had a little bruise at the injection site, so I realised I'd had it. They did it just as I was holding my babies for the first time and was completely unaware that they were doing it.

I'd say that if anyone feels it's important to them not to have it then it's their right to have their way.
Personally, I just like the third stage over and done with so I can get on with getting to know my baby.
:D

Layla,
I did not know I'd had a needle (I have a HUGE phobia) so it weas a good thing, but I had no idea it was just given to me once maddy was placed on my chest....

I have discussed with DH about the cord & placenta etc, as his custom is to take it home & bury it, as it is believed that the placenta is the babies spiritual twin & where it is buried is babies land & family & ground....

But we have discussed donating the blood & will have to see if we can donate blood & yet have placenta to bury? which I doubt & then he said its' my choice if I want to donate or go by our custom.... I will decide once I know more!!!!

I had the injection, I was never asked the OB just told me he was going to give me an injection to help me deliver the placenta.

Gemma,

Sarah Buckley, the author of the article on the BellyBelly site sent me this reply for you:

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Cord blood banking involves taking 100 ml or so of blood from the baby at birth. This blood - around 1/2 a cup - represents around 1/3 of the newborn baby's total blood (equivalent to 1.5 to 2l in an adult). This blood is needed to fill up the baby's organs that are not used (and therefore not supplied with blood) in the womb- liver, kidney, lung gut and skin. Cord blood collection requires early cord clamping, so the baby does not have the chance to get this extra blood, which is transferred to the baby from the placenta in the first 1 to 3 minutes after birth. The baby who misses this blood is more likely to become anaemic in the first 3 months, because they also miss the iron that is in this blood - equivalent to the iron in 100 litres of breast milk.

Banking this blood for the baby's own use is promoted in the US by private blood banks, who make their money by charging hundreds of dollars for collection and storage. The chance of this blood being useful for the individual in the future is extremely low, especially because many of the health problems the child could suffer would also be present in the blood.

We also do not know how long the blood will last, especially when standards of storage may not be perfect in the private system. Altruistic donations of newborn's cord blood for public use have the same problems, in that they require taking this 100 mls of blood. The question you could consider is this- would you allow someone to take 1/2 cup of your newborn baby's blood, because it may possibly benefit someone in the future? Or, for that matter, would you offer 1.5 to 2L of your own blood? (This is 3 to 4 times the 500 mls that blood banks take). The updated version of the "Leaving Well Alone" article (on issues like this) will be published in my upcoming book, Gentle Birth, Gentle Mothering, due out in October. See http://www.sarahjbuckley.com .

Thanks,
Sarah

Thanks so much for your replies, and thanks Kelly for posting Sarah's message.

Unfortunately we are still undecided on what to do. DH is one that likes scientific proof and details on both options. A few years ago I donated bone marrow to a baby with leukemia but unfortunately she died. This is what got me thinking to donate the cord - the chance to save another life. But I don't want my baby missing out on the blood if she needs it.

Will do some more research and thinking on this....

Hi Gemma. Like Shannon said, I wasn't given the needle when I had Angus in hospital, and it was fine. Placenta didn't take long, about 15 mins. The afterpains were quite strong (I'm told they get worse with each baby - great, lol). The needle wasn't even suggested to me, but I had a great midwife. Funnily though, for both my homebirths I was given the needle, although with my knowledge and consent. With my first birth I bled more, so the midwife, observing this, probably thought it a good precaution. I'm pretty sure it was done after the placenta came out though, so was more for encouraging the uterus to contract back down. With my second birth I was given the needle pretty quickly, perhaps they were more nervous about bleeding with me being at home, or because I bled a bit the first time.

Anyway, you don't need the needle as a routine thing! They should observe your third stage and blood loss and how your uterus is contracting back down closely. It's there if it's really needed. You don't have to agree to things just because they say it's standard, and they can't do things without your consent. Having said that, the needle's not a big deal imo.

The cord on the other hand..... I always say I want the cord to stop pulsating before they clamp & cut it, and they always have. I hadn't heard about any link to jaundice though, but Lola did have a bit for a couple of days. A bit of sunlight filtering through lace curtains was all that was needed. I figure it's best to let the cord behave naturally, and it's only a few minutes before it stops pulsating.

The cord blood thing, well I'm shocked after reading this thread. I filled in the form to donate cord blood this time. I didn't hear back so I rang them, and they don't do it for twins cos they're worried about getting them mixed up. Anyway, I asked questions about how it affects the cord clamping and was told it doesn't affect it at all, that you can still allow it to stop pulsating first. So either the woman on the phone was lying to me or didn't know what she was talking about, or Sarah Buckley has it wrong. I didn't know it was 100 ml either. I love the idea of donating cord blood for kids with leukamia, but I'd be asking a lot of questions of the cord blood bank people. If they want us to consider doing it we deserve to have accurate information about it first!!

Sarah Buckley said she's pretty flat out to do a longer reply but would like to add this:

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I agree that you need to get lots of information and ask lots of questions. The best person to speak with is someone who actually does the collection- the literature seems to be either evasive or ignorant about the importance of the timing of clamping from the baby's perspective.

The public cord blood banking literature says you can wait for the cord to stop pulsing, but when I spoke with someone who actually does the collection, she told me you won't get much blood out if you do this (because the baby has gotten the full placental transfusion). She said they need to clamp within 1-2 minutes max and they prefer to clamp the cord just after the baby has taken the first breath.

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Very interesting Kelly, great to get that reply.

Thanks Kelly for posting Dr Sarah Buckley's reply and your thoughts Yvette and Shannon.

I spoke with my OB and the hospital that I am going to does not collect cord blood for public use, so that decision was an easy one. My hospital is Knox Private but the Angliss (public) does it. My OB said it took him 6 years to get cord blood collection for the Angliss.

DH wants me to have the needle so I will probably have it. I also spoke with the OB about early and late clamping and he said that it doesn't really matter as the baby's lungs will take over whenever it is clamped. DH and I are still thinking this over.

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DH wants me to have the needle so I will probably have it.

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But does this mean your preference has changed or does it mean that it's not being given a thought as to what you want?

In just my opinion, I would love for baby to breathe on it's own, when it's ready. Not when the cord has been cut iykwim? But it's important that each partner has their feelings heard and one person doesn't feel like they are giving into the other. Not saying this is the case here, but that communication about all this is so important ;)

DH is concerned about me bleeding and from what the OB said and other BB members, it does not seem like it will harm the baby if I don't deliver the placenta naturally. I do see labour as 'ours' rather than mine as the baby is both of ours so I am open to DH's opinion. Still pondering over this and will look up some more info on psychological third stages as Shannon suggested.

Both times I've been given the syntometrin needle, it's been after the placenta was delivered, not before.

What Shannon said ;)

Hey Gemma - well DH and i have decided to go with a physiological third stage as we would like bubby to get all his/her blood, stem cells, nutrients etc, but obviously if i start to bleed too profusely then we will have the injection. Our B/C is happy to do this as they are all for natural third stage.