Benefits of a physiological third stage????

[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.

[Janie]

Okay......so natural 3rd stage for dummies............

If hospital midwives aren't necessarily trained in facilitating a natural 3rd stage, what do I need to know to help ensure a smooth one? I am going to chat to my Ob about it next week, and AFAIK he is amenable to not giving synto, but I would still like to be informed for when it actually happens.

TIA

[Snacks]

Hmmm, interesting question Janie. I'd be interested to hear from MWs out there who regularly attend those kinds of births.
FWIW, I think (as has already been mentioned) you need to specify that you want to delay the clamping of the cord until it has finished pulsing and it's a good idea to breastfeed to assist with the contraction of the uterus.
Personally, I found the delivery of the placenta the second time was much quicker even without the shot (the first time I had the shot) but I'm not sure if that's common or not. I think the other thing the MW would have to judge is how much blood loss is normal and how much is excessive. They obviously have to know this anyway, but I think mine was really anxious about this and very worried about how much blood I was losing, whereas if I had've had the shot I wonder if she would've been so worried, KWIM?

[femme]

Janie

I will say that most obs know very little about physiologic third stage and may try to frignten you off it with warnings of bleeding to death etc

try this:

The Third Stage Maze : Child Birth Information

[Janie]

My Ob has been practicing for over 30 years, and used to routinely observe/manage natural 3rd stages with his patients. I would guess that he routinely uses synto these days, but I am confident that he is knowledgeable about physiological 3rd stages.

Thanks for that link, it has some useful info

[femme]

I recently recieved the latest edition of 'Down to birth' the magazine of the home midwifery assoication of Queensland and it is all about hnouring the placenta. Articles include: lotus birth, placenta musings, placenta rituals in other cultures, homeopathy and the placenta, placentophagy exploring the taboo

HOMEBIRTH.ORG.AU - Homebirth Information, News and Support

You can order copies for 7-8 dollars this includes postage.

[julietp]

hey there,
I don't recall having a jab with my last pregnancy. It seemed as if the placenta was delivered quite quickly but then, my son came into the world really fast so may be I dfidn't have time to notice!!

[femme]

Janie did you talk to you Ob about this and what was his response ?