Uterus massage is it necessary? & PPH?

From memory (which isnt great being 5yrs ago and the brain after just giving birth etc)
and alot from what ive been told from DH.

I delivered bub, drug free i had some artificial water breaking (after my waters broke) as it broke and some of it didnt and was hanging around bubs head and the exit..

I laboured standing up, i couldnt stand still, it was painful to lay down.. my body was saying 'move and keep moving and we can deal with the pain' so i did..
I did have alot of internals (all requested by me) partly because with each shift change the midwife did not believe i was that far into labour and another at the end again because altho i didnt feel any urges to push there came i time where i just knew i could push (i think they were weirded out that i was smiling??!! and calm??!!)

I pushed/delivered standing up bent over the foot of the hospital bed.
i dont remember what happened much after that.. but the cord was clamped, bub taken away crying to get dried, checked?(she scored a 9) and bundled up in blanket.. meanwhile i was on the bed asked if i wanted the synotocin for the placenta (which i thought was normal to have??!! i gave my consent)

Im not sure when the pushing on the tummy happened..the placenta was delivered heaps quick and was checked.. i do know that they kept pushing on my tummy and blood kept coming.. hubby says the midwifes (2-3 now in room) looked quite worried and one left to get someone more in charge or with more experience was asked to come in and check.. the bleeding eased up, i was never told there was a problem.. i grazed only.. (im not sure what that meant) but my labia minora was torn on 1 side(is that the 'graze?') By the time they were looking it, it had stopped bleeding and they were happy not to stitch up and so was i!

clearly if i did PPH i would have been told and put on a transfusion and had to lay still or something??
was the pushing or massaging of the uterus really neccessary? how could i clot if all the blood is being pushed out (if thats why they do it) Is there any reason why i cant do the massage myself? is the massage necessary when breastfeeding?
At my whatever-week-checkup all was fine and good with uterus size.
Its something thats been on my mind all these years and im not sure i want anyone touching my belly after the bub is out.. im wondering if how i laboured and delivered had anything to do with how much i bled?
I wasnt told anything about the bleeding (i can understand why) but DH was left to worry and wasnt told anything either..

id appreciate any help and links if u have any! TIA
srry if ive put this in the wrong place..

As far as I know palpating your stomach after birth isn't necessary in a normal situation. After 3 of my births I did have them give a quick push down just above my pubic bone as I was birthing the placenta. I did have a retained placenta after my third birth and subsequently a PPH, and they did do a lot of palpating in that instance trying to get it to come free. Lucky you getting asked if you wanted syncto for the placenta though - most of the time you just get jabbed before you even realise (and it is an option to say no too).

With a PPH you don't always need a transfusion though - some women recover on their own with no issues at all. I did have a transfusion as my haemoglobin levels weren't rising at all. You don't need to have a lot of rest or lay down either, just take is easy really, but you would do that after bubs anyway. You wouldn't necessarily have been told either, different hospitals will have a different idea of what constitutes a PPH - for some it is a loss of more than 500mls, others it is less than that. So maybe they were happy that you stopped bleeding and they didn't think it severe enough to call it a PPH, who knows. Have you thought about requesting a copy of your notes at all? It would be written in there.

Im not too sure about the pushing bit, because I had a c/s and had a PPH of 600mL and no transfusion but had to take iron tabs for 3 mths after the surgery, so it must vary per person I guess. HtH!

:bump:
I was going to ask the question too as to whether uterine massage is necessary. It is the only part of the birth 2nd stage onwards that I found excrutiatingly painful. (As background, I also had the synto shot and no complications, PPH or otherwise. Placenta was pulled out - cord traction.)
Does it happen to everyone who has a VB in hospital? I think I remember reading in Spiritual Midwifery an account of a hospital birth where they pushed on her belly and she was in pain and Ina May Gaskin exclaimed that it was unnecessary... (I think, LOL. I read it a long time ago now ;) )
I don't have another midwife appt til I'm 36 weeks as I'm having shared care with my GP, so can't ask them if it is routinely done and if it is necessary. What are other people's experiences/suggestions?
And ETA: (Can you tell I'm trying to work out my birth plan already?!? ;) ) what were people's reasons for electing to not have the synto shot? Was it just because it is unnecessary, or is there something more sinister that I should know about? TIA!

At my antenatal class on the weekend they said that you can either choose to have an actively managed third stage or natural. Actively managed means you have the synto, cord traction, and pushing on your stomach and natural they just leave everything alone unless something is wrong. So I guess after having the synto it's normal otherwise they leave you.

I went natural this time around - placenta took 90 minutes and I lost alot of blood/clotting - they were fantastic midwives - they winked and put down I lost 470 mls even though they both thought I would be over the 500ml so I didn;t have to have a canula inserted as my birth had been totally natural ..... they did palpate tummy after an hour and were getting a bit worried as to whether it was coming :)

On my birth plan I said I was happy to have the needle to help deliver placenta, yet after the birth cos eveything was natural they said they would wait a while if I liked to see what happened - again - I got sooo lucky and had really great midwives on shift.

I have had 2 births now when uterine "massage" was used.
The first (birth 2) was a retained placenta and PPH when the placenta had to be manually removed under GA but before they put me under there was quite a lot of trying to get it out.
The second (birth 4) I had a secondary PPH about 2 hours post birth. The massage was done (along with synto drip) to expel blood clots and help contract my uterus down which had filled with blood.

The other births there was no problems so it wasn't used at all.

From my understanding of it, massage is used to help the uterus contract when it's not contracting on it's own as the contracting down after birth is what seals off the blood vessels from where the placenta was attached.

Hi Dust
Massage of the uterus is not done if all is normal, however if you are bleeding more than normal then uterine massage can help to stop the bleeding.
For the uterus to stop bleeding it needs to contract. Sometimes this does not happen and you continue to bleed. Massaging the uterus is one way to help it contract. (the injection you had also does this as does breastfeeding).
I would say that you probably did have a heavy bleed if extra midwives were called. Many women who have a PPH do not need a transfusion, this would depend on how much blood you lost and to some degree your ferritin levels and your HB at the time of birth.
To fully explain how your uterus contracting stops the bleeding would be a little long to post as an answer to a question but if you or anyone else reading this would like to know I would be happy to post a full explanation here.
If you have any more questions I will be happy to answer them

Hey Alan, I know I should ask my midwives and I will, but I'm just curious - if I ask for an unmanaged 3rd stage, does this mean they are likely to leave out the massage?

Hi Snacks
They should not massage your uterus unless you are having a heavy bleed.
If you do have a heavy bleed then massaging your uterus can help to stop the bleeding whether you have a managed or unmanaged 3rd stage

I read in my book "BIRTH" written by midwives, that over 95% of australian women have an actively managed 3rd stage in which they are given the Syntocinon to deliver the placenta. I was surprised by this, as i was hoping for a "natural" 3rd stage and is something i am yet to talk to my midwives about. Thought it would be more popular to have a natural 3rd stage?

I am hoping for a natural 3rd stage however if it means more chance of PPH than i will go the Syno if that is what most have i suppose? Guess its hard to know until the baby is being born and how my body is going etc....

SamiH - thats wonderful you got natural 3rd stage with wonderful midwives! i hope mine are just as supportive!

Is Cord traction bad? Alan?

Hi Renstar
Yes it is true that most women will have the synto injection. Synto is given for 2 main reasons.
1 To speed up the time it takes to birth the placenta.
2 To prevent excessive bleeding.
Synto helps your uterus to contract and this contraction helps to stop excessive bleeding and encourages your placenta to detach from the wall of the uterus. However if your uterus contracts before the placenta has been delivered then the placenta can become trapped in the uterus and require a manual removal.
Most women will not have excessive bleeding after the birth of the baby. Synto works very quickly once injected. I believe that giving synto just in case you are going to bleed is like taking panadol just in case you are going to get a headache. There are a number of things that make some women more susceptible to have a PPH as there are some things that make it more likely that you will have a headache. I personally think that synto should be given to the women that are at a higher chance of having a PPH and only giving synto to the rest of the women if they do start to bleed heavily

Thanks Alan.

So I won't know if i'm going to be at a higher chance of PPH until the baby is being born am I?
That's good to know you can have the Synto if you start to bleed heavily too.

I think i'll just make the decision when the baby is being born i guess.

Thanks for that Alan. That's a relief :)
Ren, the midwives asked me about it in an appt beforehand. They told me that that's what they usually do and I just shrugged and said ok - I was I ok with it. (They should ask you before birth, though.) I seriously doubt that you will care either way when the time comes! Think about it beforehand. Have a read of this BB article Here.
The only reason why I decided to look into it is because the uterine massage was reeeeeeally uncomfortable. Now I have some additional reasons to request a natural third stage :)

Thanks Snacks for that link to the article, very good article.
It's given me lots to think about and ask the m/w's about at my 36wk check up.

Dust -sorry if i crashed your thread :redface:

Now that's odd. I had a natural third stage labour with DS however my midwives did massage on me for a couple of days after the birth when they came round for visits. Is that not the usual? DS was born on due date but my placenta was deteriorating (his growth slowed right down from 35 wks). Do you think that is why I had to have massage as there may have been a higher risk of leftover placenta???

Just curious as I'm due with #2 later in the year and I thought I understood everything from my previous birth.

Hi Helenn
Sometimes the uterus does not contract as firmly as we would like it to. Massaging the uterus causes it to contract. So I can only assume that your fundus (the top of the uterus) was a little soft (boggy)

Thanks Alan. That rings a bell now.

one interesting thread now ;)

I delivered the placenta without any synto, pulling or massaging with no#2 it came 15mins after which i was thrilled about. Much less bleeding that time around too. But i did have the synto after delivering the placenta coz the midwife said just in case... they did offer to help get the placenta out but i wasnt going to have a bar of it.

Im really going to have to try and figure out the bleeding for myself with the one on its way in august... and put my foot down if i dont believe i need it. I really did bleed less this time around and im happy with that. :)

Great to hear, dust! Gives me confidence to ask them to refrain from touching me with either needle or massaging hands during 3rd stage ;)

I don’t use synto routinely for homebirths. When working at a hospital I always give the woman the option not to have the synto.
I believe that giving synto as the baby is being born is like taking some panadol at bedtime just in case you are going to have a headache in the morning.
Synto acts by causing the uterus to contract and thus helping to stop excessive bleeding and expelling the placenta.
The down side is that it will also cause the cervix to close and there is a chance of trapping the placenta inside the uterus.
Also the majority of women do not bleed excessively after birth. Synto, once injected works very quickly so why not give it if a woman starts to bleed excessively and not because there is a chance that she might.

:

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I don?t use synto routinely for homebirths. When working at a hospital I always give the woman the option not to have the synto.
I believe that giving synto as the baby is being born is like taking some panadol at bedtime just in case you are going to have a headache in the morning.
Synto acts by causing the uterus to contract and thus helping to stop excessive bleeding and expelling the placenta.
The down side is that it will also cause the cervix to close and there is a chance of trapping the placenta inside the uterus.
Also the majority of women do not bleed excessively after birth. Synto, once injected works very quickly so why not give it if a woman starts to bleed excessively and not because there is a chance that she might.

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Alan,

I am put on drip fed oxytocin after the baby is born due to a PPH I had with my 3rd baby. I've never really thought about the whole thing at all and they have *never* asked if I wanted the synto because I am Vaso-Vagal Trypanophobic. Basically, don't let me know there is a needle involved and and I suffer neither serious blood pressure spikes and falls and I am less likely to react unreasonably. Since the PPH I worked very carefully with the pathologist at my then local hospital to get me to a point where I can accept a canula from her only. The hospital was amazing in so much as they would get her in just to be able to do it for me.

However, I am now 3 hours away from that hospital and my anxiety about getting the canula has completely returned. Would it be possible for me to go back to the syntocin and uterine massage after cord traction removal? I could try and ask if they would let me see the pathologist for the canula here and see if that works, but it took a long time to train one hospital how to deal with a trypanophobic. I don't think I have the time to do it again. :(

Hi Inertia
This condition must be very frustrating for you. I can only imagine some of the derogative comments you must have received from people who do not understand your condition.
As to whether the hospital would let you go the synto and uterine massage would be up to the hospital. It would depend greatly upon your past obstetric history, for example how bad was your PPH, did you have a PPH with all your births etc.
The problem with a PPH is that, if it is a bad one, you can lose a large amount of blood very quickly. By putting a canula in prior to the birth makes it possible to give you not only drugs but also fluid and even blood if it is needed.
It sounds like your phobia is quite extreme, I would suggest that you really need to talk to the hospital about your condition and see what provisions they can put into place to try to ease your fears.

Forgot to add that you are at an increased chance of having a PPH because of the number of children you have had. Most hospitals would prefer you to have a cannula inserted well before the birth of your baby.

Alan, you could probably believe some of the comments I have heard. The worst and most common is when people call me a 'baby'. No one seems to understand that there is a very real, and very dangerous phobia against medical needles. My XHs mother was feral about it for months until she saw my legs give way under the blood pressure low after I was jabbed by a needle for a barium meal. I have had it since my first barium meal when the assistant that did the injection collapsed a vein in my left arm. They cant use that arm now because the vein is so very small now.

The PPH was severe. It went undetected for over an hour because my sister was there with the two older children to see the new baby. It was her (an AIN) that worked out there was something very wrong and ushered the kids out after she hit the panic button. I lost 3l of blood and was transfused overnight. I remember they tried the Syntocin first and then when I woke up I had the canula. I remember the last canula vividly, it was like a straw. The two before that were small, but I arrived at the hospital only a few minutes before baby was born so they just got someone to put one in.

I will discuss it with them, but from the sounds of things I am going to have to work with them with the phobia. Its really not helping that my support network went from dozens of people to 1 person in the last 2 years, but my mum and another sister are planning on coming down from QLD around then to give Phil a hand with the kids. Just wish it was my older sister (the AIN) as she has been the one that was always with me when I had to have a blood test.

Thanks for your advice, I will certainly talk to them about all my options. Guess I am just lucky I have never had a tear! :lol:

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