Uterus massage is it necessary? & PPH?

[dust]

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..

[Trillian]

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.

[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.

[helenn82]

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.

[Alan]

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)

[helenn82]

Thanks Alan. That rings a bell now.

[dust]

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.

[Snacks]

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

[Alan]

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.

[Inertia]

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.

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.

[lalitearns]

Hello. i like to know the right method massage at the time of labour.