Benefits of a physiological third stage????

[BellyBelly]

TK, I would make it clear to both. You'd have a birth plan I assume, so you'd give a copy to your Ob and take a copy into the hospital too. On the BB birth plan templates I have, its got a signature at the end of it for the Ob to sign to say he's supportive of your wishes, so you just show the hospital.

[tk1999]

Thanks Kelly! I didn't know there were birth plan templates on here... with my doula we wrote our own and I included things I had seen on here but didn't know there were templates

It is true - you learn something new every day! Off to search for the template - thanks again Kelly

[Inertia]

I had 3 non synto enhanced third stages. Although they did clamp quick and give a tug every now and then. I remember with my first they were unhappy with how long it was taking and threatened me with needles! The third was fine at first - only it wasnt very phys. Lyta went pass the parcel and I was exhausted, so I did suffer a large pph. Since then mine have been completely managed.

So 1 out of 3 went sour and none really followed a true phys third stage.

However, my mum had 7 kids, all natural births, all but one were true phys third stages - no complications at all.

[Fleur]

Can I ask - I am going to a public hospital as a private patient - will it be the hospital's 'policy' or my Obs stance that I should be looking into???

Good question...

I have really left mine a bit late ...I should have brought this up at my 36 weeks appt. I would be asking for both although I imagine if you are private, your Ob would have more sway. However I have heard stories of Obs not making it for the birth.. in which case it might come down to who is there at the time kwim?

BUT regardless of that it is my understanding that this is your choice - they can't force you into any intervention?

Kelly - I'm pretty sure that's what happened with me - they just assumed that's how it would be done. I don't recall ever being given a choice. So I want this in my birth plan either way. If I do end up with a managed third stage, I would like it to be because I have made an informed choice...

- Whoops missed some of the replies here before I posted

[BekZ]

I had a retained placenta with DD2. I had the injection straight after birth and then was hooked up to a drip of syno (I think) for 1 hour post birth and the placenta would not move. I ended up having the placenta removed manually.

During this pregnancy I have asked every midwife and ob that I have seen about managed versus natural 3rd stage. Two of the mids have told me that if my placenta is going to be retained then no amount of management is going to move it, and both could not see why I shouldn't try a natural 3rd stage. The others, including the ob have basically insisted that I have a mangaed 3rd stage "just in case"!!!

Well I am confused!!!!

[Fleur]

...but 'just in case' what Bekz?

This is what I don't get...what is the worst that could happen with at least seeinghow things go? Can you do that, just see how it goes and have the injection etc if you need it?

[tk1999]

I am seeing my Obs in his rooms next Friday so will ask him then about third stage and his stance v hospital stance. I don't see the middies at the hospital until I am in labour (well that is the plan anyway) so will have to find out how I can see them re birth plan.

Thank you for this thread - it made me realise I need to start looking into these things a lot earlier than I thought I would!

[Willow]

Tk - I am a private patient delivering in a public hospital too and all of these things were discussed and decided upon with my Ob, not the hospital. I did my birth plan and I discussed it with my ob around 37ish weeks, there was some negotiation on delayed cord clamping (it was delayed but not until it stopped pulsing, my ob likes to take a sample of the blood from the cord for testing and I was happy with his explanation and reasoning for this) but I was happy enough with the end result.

I just took a copy of my birth plan in my hospital bag but didn't actually end up having to give it to the midwives. I got there, got in the bath, had a bit of gas and then by the time I was ready to deliver, my ob was there and took over.

I need to do my birth plan!!

[alioops]

I had a physiological 3rd stage with DD3. I had to sign a consent form declining the synto. I had synto during labour and the MW turned it off as soon as she was out. I delivered the placenta 15 minutes later while I was trying to attach DD. I told the Ob when I asked for a physiological 3rd stage that there was no point in giving me the synto if BFing would do the same thing and I was only cutting the cord because I wasn't sure that I could effectively care for the placenta with the way my pelvis was. She just told me what to look for WRT infections and told me that if I had more bleeding than I had with the older 2 to let the MW know. I bled LESS this time than with the other 2!!

As soon as the placenta arrives the MW is supposed to check it over and make sure it is complete. They should know pretty quickly if you have retained any.

[Shades]

Just some food for thought - the way I had it explained to me was that while physiological third stage is a great choice (delayed cord clamping etc) if you've had a completely natural birth, it can be a bit silly to insist on it if you've been induced/augmented/pumped full of artificial stuff because then your hormones are all stuffed around anyway and may not do what they're supposed to!

[BekZ]

Jasp - My point exactly "in case" of what??? Interestingly the Ob I saw did not offer and alternatives to a managed 3rd stage, but the midwife told me that I have heaps of time to wait and see what happens. She told me not to be bullied into a managed 3rd stage if I don't want one.

Shades - I had a completely natural birth (not even panadol) and still ended up with a retained placenta and pumped full of syno.

[Shades]

Shades - I had a completely natural birth (not even panadol) and still ended up with a retained placenta and pumped full of syno.

Okay so it can obviously still need help - I think the point was more that it was silly to try and insist on a physiological third stage if the rest of the labour/birth has been fiddled with...
Make sense?

[BekZ]

Shades - Got ya

[Shades]

Sorry - should have explained it better in the first place - I blame the baby-brain!

[Snacks]

Can you do that, just see how it goes and have the injection etc if you need it?

Yup. My hospital's policy is to inject with synto regardless. However I asked if I could try without (and I had heard that the synto shot works quickly & efficiently if PPH begins to occur) and they allowed me to do so. (I had a birth plan on file but that midwife hadn't read it. I had prepped DH beforehand to tell the MW what I wanted.)
Placenta came out whole within 5 minutes. Unfortunately I did have some heavy bleeding and they asked me if they could give me the shot because they were worried. I ended up needing two shots to control my bleeding, but otherwise all was fine and I'm glad I gave it a try.
As for delayed clamping, I believe that's becoming a more popular choice and my MW was certainly very happy to wait for the cord to stop pulsing.
GL!

[Fleur]

Snacks, that is pretty much exactly what I needed to know, thank you!!

I think that is what I will do - ask for the clamping to be delayed & just see how the rest of it goes.
I understand the needle is less painful if given at the time of birth, when you are distracted but I can handle it if I need it later I don't mind having it if I need it, and I do't really want to take 2 hrs to birth the placenta! but I can't see the point in messing with things if it's not necessary, kwim?

Will let you know how it goes soon hopefully!
Thanks to everyone for your replies


Bekz what are you thinking you will do? are you going to go with the Obs or see how it goes? I don't see why you can't do that this time (see how it goes that is).
ETA - Ok I'm not a mw or a dr but it makes sense to me that if you were hooked up to the synto last time & it did nothing, what would be the point in doing it 'just in case'? Especially if with DD1 you had no probs?

[Snacks]

Glad to help, Jas. Hope your MW's are supportive Will look forward to hearing how it goes.
(And the shots aren't painful IMO - especially when you've so many endorphins floating round your system. You'll be on that 'birth high' for a while after your baby comes out )

[alioops]

Okay so it can obviously still need help - I think the point was more that it was silly to try and insist on a physiological third stage if the rest of the labour/birth has been fiddled with...
Make sense?

Just some food for thought - the way I had it explained to me was that while physiological third stage is a great choice (delayed cord clamping etc) if you've had a completely natural birth, it can be a bit silly to insist on it if you've been induced/augmented/pumped full of artificial stuff because then your hormones are all stuffed around anyway and may not do what they're supposed to!

That's how the Ob explained it to me. I still pushed for it and was still contracting heaps to get it out after the synto was switched off. The pushy feeling didn't stop till it was out. The synto was only meant to give my body a little push in the right direction but the Ob got called into a CS and couldn't authorise switching the synto off for the MW, even though she said when I agreed to it giving me a little push in the right direction it could be switched off when I was making progress, so having signed the consent form was the quickest way to get it switched off. If I had bled too much it was still connected and would have been easy to switch back on if I needed it.