Syntocin - optional or must?

After my last bi-weekly check up [I'm on weekly ones now], the midwife at the clinic spoke to us in general about my birth plan and I explained to her that I had done it and will bring it in next week.

That said, she still went through the basics with us and when she asked me if I wanted the syntocin, I wasn't sure coz I wasn't really prepared for a Q&A session with her. I asked her what it was all about and she said that it was to help the delivery of the placenta and to minimise the bleeding. I remember in my birth plan that I wanted to deliver the placenta naturally. Would this mean that chances of bleeding would be higher?? :doh:

I never wanted it for DD....they knew it... and still jabbed me....i then began bleeding heavily and was jabbed with another kinda drug to control it.

From what ive read, and from the birthing classes last time (and might not be right), but they like to do it when theres been a trauma birth, by that i mean forceps or vac extraction. I had a Vac for DD but placenta came out in tact and nothing wrong with it, 3 mins to deliver.

This time im stating DO NOT give it, and i also wanted to let the cord stop pulsating before its clamped and cut, so i dont think i can have it any how.

You don't have to do anything you don't want to do. We are having a completely natural third stage with this bub. Why have more drugs than you have to?
Kim, I can't believe they gave you the shot after you told them not to! That is terrible.

Nope, you don't have to have that at all. I didn't want it but had it because I had what they term "trauma" birth where he was vac assisted and I was bleeding a bit so ob suggested it would be a good idea. So we made the decision to do it based on advice. I think it's something which is a little hard to make a FIRM decision on until you're there IYKWIM? Something you need to be open to in case it's a good idea at the time.

Check out this article on the main BB website regarding third stage of labour. Might help with your decision.

HTH

You do not have to have anything but you need to know the risks.

Often hospitals are happy for you to have a physiological 3rd stage as long as you are happy to have it if you do bleed, most peopel do not loose much blood and a physiological 3rd stage means you can leave the cord still pulsating until it natuarally stops and not clamp the cord immediatly.

Ways to help the placenta come out is putting baby to breast if cord is long enought or nipple stimulation by fingers.

yea, that was what i thought too initially but seeing that i spoke to 2 midwives n they said that it would be given - i was just confused. maybe i should check with my ob to see what the policy is with my hosp. i've always thought going au natural would be good. i've also planned to wait till the cord stops pulsing before cutting it.

I didn't want it and wasn't going to take it, but my 3rd stage was a bit long (actually about 7 minutes before the injection, about 5 more afterwards, not long in real life, just long if your used to medically managed 3rd stages, which my midwives were) and my midwives looked worried. DD was a bit blue at her 5 min APGAR (scores 9 at 1min, 7 at 5min, 10 at 10min) and i wanted them to focus on her and not worry about me so i let them give me it. My placenta came out when DD was pink and breathing well (before she was interested in feeding though) so i think my body was just tuned into her, despite the cut cord, and waited until she was fine before ending life support iykwim.

As an aside, my worried midwife began cord traction when i declined the synto 1st time. I was more worried about my quiet bubs but i remember wishing she'd stop, that was another reason i took it - i felt the synto gave less risk to me than cord traction. I also should say that i'd hoped to avoid the synto because i wanted a natural birth but by then i'd already used the gas and air so i was a little bit "what the hell" about it. LOL.

Bec

A placenta has one hour to come out after the baby is born.
A physiological 3rd stage does not have any cord traction it is physiological because your body does it alone without anyone helping or drugs. (apart from you maybe giving a little push!!)

Feeb, I also thought that if you have the shot to get the placenta out that you have to cut the cord immediately. But some people on here have said otherwise.
Maybe we can get a midwife or someone to clarify to stop the confusion (well for me anyway:D).

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Furthermore, if the cord is not clamped before the oxytocic effect commences, the baby is at risk of having too much blood suddenly pumped from the placenta by the over-zealous contractions.

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Actually I just found this in the article that Sarah H referred to.

Well a natural birth is one without drugs or intervention like ARM, but i'm unclear on whether cutting the cord before the 3rd stage is over or using cord traction to hasten the 3rd stage counts as intervention or if it comes under the same category as VE's etc. I thought a physiological birth was just a vaginal one without instruments...? Kelly's not about today...Julie? Can you clarify?

Bx

Ah, thanks for clearing that up Shannon - does that mean if mum is totally drug-free throughout but the midwife pulls on the cord she didnt have a natural birth?

Tell you what, i found syto STINGS! I commented to the midwife and she was like, "yeah most women don't feel it as their baby has only just emerged and the pain focus is still the crowning feeling". It wasn't agony or anything, i just wasn't expecting it as practically everyone i know had it and none mentioned it. By they didn't wait like i did.

Bx

All interventions are technically optional as they can't do anything to you without your consent but you will need to check with the hospital policy. The hospital I attended (a low risk facility), was their policy to give the injection and if you were going to refuse it (obviously before the baby is born)they wouldn't let you deliver there. Having said that, the injection wasn't given to me immediately so my daughter was given the benefit of the extra blood first. You need to do what is right for you so make sure you are informed. I was anti injection initially and only wanted it if I started to haemmorrhage, but then it was explained to me that it may be too late then and the injection won't necessarily stop a haemmorrhage that has already started, which made perfect sense to me as prevention is better than cure, so I went with it. In all honesty, I didn't care what they did to me after my DD was born as I was so amazed at her. The prevention is better than cure thing works for me as I have a medical background and that is how I would manage all of my patients so it made sense to me. Good luck with your decision but defintely check out the policy of the hospital, although it sounds like you can decline it otherwise they wouldn't have asked.

I guess my main reason for asking whether the cord needs to be cut after the injection is that I would hate for women on this forum to think that they can let the cord pulsate after the shot if is not true. I don't have a medical background, so I don't know anything about it, only what I have read, and that was that once you have the shot the cord needs to be clamped. I could imagine it would be pretty awful for someone here to go into labour thinking they can have the shot only to be then told afterwards the cord needs to be cut when it wasn't what they wanted.
My homebirth midwife actually doesn't do the synto shot as routine so that to me (and I trust her completely) says it is not necessary for everyone because I am sure if it was dangerous then she would do it.

ok...now i'm blue in the face trying to take in all that has been said! lol :P

correct me if i'm wrong here coz this is MY understanding....

syntocin is an option depending on the hospital policy. if it is given, cord clamping has to be done sooner than if u dont get the shot, hence, you cant wait till the cord stops pulsing before cutting it, right? and that isn't all that good coz bub may need that extra blood to get all the organs going. did i get any of that right?

now, i have another related question but will start a new thread for it so that it wont cause confusion. :)

All the extra blood is most definately good for the baby. Cord cutting after the shot, I am still confused on that one myself!
Syntocin being an option depending on hospital policy, well personally, if I was having this baby at hospital I would be telling them they don't have permission to do it regardless of their policy.;)
Good Luck making with all your decision making.

Sarah Buckley's article on "Third Stage - Leaving Well Enough Alone" helped me get my head around this.

Basically, the natural oxytocin your body produces does the job of syntocinon (which is artificial oxytocin). Oxytocin first causes your uterus to contract to push out the baby. After the baby is born, oxytocin causes the uterus to contract and expel the placenta - the contracting clamps off the blood vessels so you don't haemorrhage.

Oxytocin is pretty amazing, it's the "Love Hormone" that is responsible for orgasm as well as birth! It is also responsible for the let-down reflex when breastfeeding. So the things that help those activities, likewise help the flow of oxytocin after birth so that your uterus clamps down effectively and blood loss in minimized. Oxytocin also enlarges the blood vessels on your chest - creating a natural heating pad for the baby to lie on and stay warm. That's one reason why they encourage skin-to-skin cuddling right after birth. Then the baby, snuggled up warm with mum, smells this heavenly smell and gradually becomes interested in the nipple. The nuzzling increases the release of the oxytocin. And that helps the placenta detach, and the uterus to involute and expel the placenta. (That's why "nipple stimuation" is suggested as one way to get labour going - it stimulates the release of oxytocin). Oxytocin, the "feel good hormone" is the magic behind all of this!

A quiet, warm room, with dim lighting and gentle voices also helps optimize the release of natural oxytocin.

My understanding is that with gentle, patient care, if all the above is unfolding naturally, there is no need for artificial syntocinon. I see no need to use it routinely or prophylactically - I would prefer that it is reserved to use only when actually indicated - for example, if my blood loss was too much for any reason.

It is not necessary to clamp the cord or pull on the cord (even gently) during a physiological third stage. Sometimes kneeling up, or sitting on the toilet or giving a cough can be enough to gently birth the placenta. Some parents don't cut the cord until after the placenta is out, and some don't cut the cord at all (Lotus Birth). These are all options.

Julie i did NOT want her to pull on the cord as i've actually heard that can be dangerous but my brain was still in my arse and i figured if she was that worried she could just give me the shot (after which she left me alone). I've read where cords have split before going into the placenta and are a bit weak (where you can't SEE) and have torn or snapped right off during traction. I also saw veterinary cord traction invert a cow's uterus - not good!

My notes say i lost 150ml (estimated) and my midwife said she'd over-estimated because i was at home, so it was more like 100ml, so i doubt i needed the injection at all.

It definitely depends on one's midwife. My friend's cord went on pulsing for 38 minutes and her placenta came 15 minutes after it stopped and her good German midwife didn't bat an eyelid.

B

Having the placenta birthed via controlled cord traction and having the synto needle does NOT mean that you still dont have a natural birth.

Leaving the cord pulsating you dont have the needle at all as you hold your baby close to you and the skin to skin contact releases natural syntocinon and placenta comes away from wall of the uterus.