Uterus massage is it necessary? & PPH?

[Beach Mama]

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!

[Snacks]

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!

[Heaven]

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.

[SamiH]

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.

[~Raven~]

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.

[Alan]

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

[Snacks]

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?