Benefits of a physiological third stage????

[Taurean]

I had considered doing a natural third stage but my OB recommended against it. He said there is a higher chance of haemorrhaging if you opt for a physiological approach and he has witnessed it on several occassions. That was enough for me to think twice about it.

I did a bit of research and often it's fine to deliver the placenta without any drugs but I figured it really isn't going to hurt me to have the shot and get the placenta out sooner rather than later. After all that hard work I think I'll be quite happy to finish off the labour and get on with just bonding with my baby.

That's just my personal opinion though.

[Lulu]

To clarify - delivering the placenta doesn't hurt, it was the jab in the butt that did!

Also, it's not a hassle birthing the placenta - it usually comes out whilst you are sitting up holding your bubba, so it's not like you are waiting around for it to make an appearance!

[BellyBelly]

Here's some good links for you:

Why Delayed Cord Clamping is Good For Your Baby (and you!)
Third Stage of Labour: Benefits of a Natural Approach
Pain in Labour: Your Hormones Are Your Helpers
https://www.bellybelly.com.au/birth/...rint-for-labor

[Taurean]

Also, it's not a hassle birthing the placenta - it usually comes out whilst you are sitting up holding your bubba, so it's not like you are waiting around for it to make an appearance!

I know it's generally quick but not always. A friend of a friend took 2 hours to deliver hers. She's opted for the shot with her next labour.

[Fleur]

Thanks for the replies everyone.

I am wondering if maybe we can delay the cord clamping for a bit and then have the needle etc if it seems necessary? I don't know how long I'd leave it though, or what hosp limits would be before they deemed it necessary.

2 hours does seem a bit long...

[Taurean]

Thanks for the replies everyone.

I am wondering if maybe we can delay the cord clamping for a bit and then have the needle etc if it seems necessary? I don't know how long I'd leave it though, or what hosp limits would be before they deemed it necessary.

2 hours does seem a bit long...

Yeah, good questions. I don't plan on delaying cord clamping (no one shoot me!) so providing the shot is given to me after the cord is cut, then the drugs can't be transferred to the baby.

Would be interesting to check with your midwife/OB as to how long you can wait though.

I was suprised by the 2 hour marathon as I don't think it's all that common, but it really made me think twice about it. Each to their own I guess

[Sequoia]

I was holding DS on my chest when the MW asked me to give a little cough and the placenta came out all by itself.

All I could think about later was how I didn't I cover my mouth when I coughed!

[Cheeky_Monkey]

Please excuse my ignorance - I didn't do a lot of research while pregnant with DS.. just assumed the midwife knew what she was doing. Bit naive I guess.

My question is this - Is it the "norm" to have the injection to birth the placenta?

I ask because my midwife had just transferred to Aus from NZ and told me that she is used to doing things a little differently from the rest of the midwives in the hospie. Everything was fine and she always consulted me about what I wanted in accordance with my birth plan.

I didn't have anything in the birth plan about the placentas delivery though. Once I was cradling DS she put a little bit of pressure on my uterus with one hand and a slight little tug on the cord. It didn't budge so she said "We'll give it a bit longer" and tried again in about 10 minutes, this time it moved so she told me to give a little push and out it plopped.

So - is this normal or would any other midwife insist I have the shot?

Sorry bit long winded.

[Mummato2]

I had considered doing a natural third stage but my OB recommended against it. He said there is a higher chance of haemorrhaging if you opt for a physiological approach and he has witnessed it on several occassions. That was enough for me to think twice about it.

My mum is a midwife and she is pretty easy going.

Her take is she has been practicing for around 40 years and seen the trend swing between both managed and physiological third stage.

Her personal opinion (which I absolutely trust and will practice myself) is that she has seen an increase in PPH with a physiological third stage vs managed.

It is a very personal preference, but she explained that the injection allows your uterus to contract efficiently after the birth and essentially cauterize off any small bleeds AND ensures the contractions birth the entire placenta - not just parts.

So based on her observations in the field, I trust medicine in this issue.

I think there's a fine balance between a wholly natural approach and making good decisions that can still make it a natural experience IYKWIM?

[femme]

If your going to birth in a hospital it is very unlikely that you wll have a physiological labour so many hinderances to a physiologic third stage.

So your saying uteruses dont contract properly or work properly without the injection well mine does .If it doesn't then give me the injection but I would rather try than just take it just in case

[Mummato2]

If your going to birth in a hospital it is very unlikely that you wll have a physiological labour so many hinderances to a physiologic third stage.

So your saying uteruses dont contract properly or work properly without the injection well mine does .If it doesn't then give me the injection but I would rather try than just take it just in case

No I'm not saying that they don't contract properly or work properly without the injection - what I am saying is the injection ensures in most cases that it prevents PPH whereas it is a real risk in a physiological third stage.

Like I said, this is such a personal choice, but I can't see the benefit of waiting TBH - once my baby is out I'd rather take no risks

[Sequoia]

If your going to birth in a hospital it is very unlikely that you wll have a physiological labour so many hinderances to a physiologic third stage.

I birthed in a private hospital setting and my OB asked me to cough, that was it. No injection.

[femme]

For those who are interested this article

Hastie C, Fahy K, 2008, Optimising psychophysiology in thid stage of labour: Theory applied to practice, Women and birth, Vol 22 pg 89-96.

The authors discuss factors which interfere with normal physiology and placental birth and that should be considered risk factors for Post partum haemorrhage. They are:

bright lights,
cold room temperature,
noisy strangers int he room.
Midwife unknown to the woman and the woman unable to maintain mindful focus. Under the influence of pethidine, morphine etc
The baby taken to be resuscitated or transferred to the nursery,
unneccesary talking,
uninvited touching of the woman or baby.
Being in a hurry to finish and clean up or carry out fear inducing activities such as setting up for an emergenc,
phone calls from family of friends.
The mother exhausted and feeling that the birth is over.
The baby being abnormal, unwanted or the 'wrong' sex. (pg 93)

Something to think about when writing your birth plan.

[femme]

mumma to 2

Yes it is a personal choice I can see the benfits of waiting and I prefer to allow my body a chance to work properly before helping it along with artificial hormones. If syntocinon prevented PPH as most women have it in hospitals then we would have no more PPH. Most women that have a PPH have already had syntocinon. It is just another means in which birth has been medicalised.

[femme]

retained placenta may be one reason for PPH however it is not the most common reason which is uterine atony (weak muscle tone). Putting the baby to the breast can also release natural oxytocin.

[jpelc]

I didn't want a managed third stage, but the doctor talked me into it. Even so, during the conversation he told me the injection only prevents 30% of pph - which means 70% of the time a woman will still have a pph even with the shot. This is what happened to me, and I had to go on an IV drip for 4 hours to stop the bleeding.
It seems to me that the only way to prevent a pph is to have a homebirth! Something I am seriously considering for my next birth.

[jackrose]

Her personal opinion (which I absolutely trust and will practice myself) is that she has seen an increase in PPH with a physiological third stage vs managed.

This is often the sort of information and opinion I like when making decisions as I think a good professional at grass roots level who has the best interest of the mother and the baby and has a 'heap' of hands on, up close experience is generally going to have a good idea of the reality.

However, it is a good idea to also have read widely and consider lots of different things when making a decision.

What jumps to mind for me is - why? Why is a natural process more likely to end in a potentially life threatening situation for the mother? Mother nature generally does not work that way and usually has incredible natural solutions for potential problems that come up.

So, my next question is, what things do we do in the modern hospital system which may interfere with Mother Natures natural safeguards?

The two things that jump to mind are

1. not giving mothers enough time to have skin to skin contact directly after the bith and to establish that first latching on therby releasing a natural surge of oxytocin. The natural version of the drug used to contract the uterus. Modern birth demands that a baby is weighed measured and tested at birth and can be whisked away too early. This is thankfully becoming less the case as we have fought to keep our babies with us in those early minutes and the hospitals have heard and responded, but I still think there is a rush to move mums on and this interferes with the natural processes.
2. Clamping the cord too early so the blood destined for the baby (that he/she is designed to have in the few minutes the cord continues to pulse) is left in the placenta. Therefore the placenta is heavier with blood than it is designed to be and is more difficult to expel.

I am not saying that the above experiences are everyones, I realise that there will be people who had plenty of time with their newborn and a delayed clamp and still had PPH. That is the nature of human beings - we always have exceptions to the rules! In these cases and in emergency cases, it is excellent that we have solutions such as drugs to inject to potentially save lives. Still, I think this all holds for a majority of people, and I personally prefer to try to give Mother Nature the benefit of the doubt.

Finally, in making my decision, I ask, what do the hospitals have to gain from following a managed vs physiological approach?

My answer to this (and other people may have other answers) is that although they undoubtedly have the mother and babies health and well-being as a high priority, I feel that they also have to answer to the bottom line. They need to move people on quickly and leaving a mother to appreciate the wonder of Mother Nature's plan does not make sense in that regard. Also, if there has already been a usurping of Mother Nature with early cord clamping, (or even a managed labour with the use of induction drugs) it may well be safer to have a managed third stage.

In saying all this, I am not wanting to judge anyone's choices by any means, I just want to share my thought process on the issue. I think everyone has a right to make their own mind up. For me, I am choosing a home birth this time so I don't have to be on the defensive when in birth asking for the right to birth my way rather than the hospital 'standard' and I'm going for delayed cord clamping and a natural third stage!

[femme]

Another reason for increased PPH ay also be that midwives themselves having been trained for so long to do managed third stages are not that aware of the what they need to provide to facilitate a physiologic birth and third stage. A previous poster also stated that they had a physiologic third stage after having an induction (with the synto drip) which isn't really advisable to mix the methods. When a labour has been managed the third stage I my opionion should be too because you have tampered with the natural course of the birth.