Labour Third Stage - Managed or Natural

[KirstyD]

Hi ladies,

I went to my first couple of NCT classes last week and i thought they were really good, much better and more informative than the NHS one i went on last week also which was a bit rushed.

Anyway to my question....during the classes we talked about the third stage of labour (i.e. placenta delivery) and that you have 2 options, natural or managed (have an injection). These options seemed to be closley linked to what you want to do with cutting the babies cord, so:

1) Have the injection, placenta is forced out quicker with the big contraction the injection brings on, usually in 5-10 mins. They give injection as baby is being born so they clamp and cut the cord as soon as baby comes out. Benefits being, it's quicker, mother doesn't have to 'push' as such and bleeding can be reduced. Disadvantages being there is a risk of having some trapped placenta and you can react to the drug with sickness, dizziness, headache, fainting. Also babies cord has to be cut as soon as it's born, and there was some research to say it's good for the baby to let cord stop pulsing before cutting it.

2) Let placenta come out naturally. Benefits being allowing you to decide when baby's cord is cut (i.e. you can leave it to stop pulsing so baby gets all the good stuff), no drugs, less risk of trapped placenta. Disadvantages being possible higher blood loss for mother, takes longer between 10mins-1hour approx, mother has to actively 'push' it out.

I have never known about these options before the classes so haven't ever really thought about it and haven't made up my mind yet what to do.

What are you lot doing?

 

[lisaspoon]

I knew that I wanted the injection as I didnt want the risk of higher blood loss.... however I also wanted to wait until the cord had stopped pulsing before it was cut....

I asked the midwife and she said to me it was possible to do this, I just dont have the injection until the cord has stopped pulsing etc and was told to make sure that this was written in my birth plan as well!

So i'm going half and half!

 

[KirstyD]

Oooo thats interesting, sort of get the benefits of both then

That sounds good, I didn't really think of asking if they could just delay the injection a bit.

Got my next midwife appointment tomorrow so i think i'll chat to her then!

Thanks!

 

[lisaspoon]

glad to be of help

I was really chuffed when I found out ..... If its the route you go, just make sure its documented and your OH/birth partner knows as well cause I have the feeling that when I get to the point they would normally inject your bum I wouldnt have a clue what was happening!!

 

[kaybee]

I've only had one NCT class so far so haven't got to this yet, but it's good to know there seems to be a compromise. Will have to make sure DH knows the plan though, as I reckon I'll probably be past caring at the time and will let the MW carry on with whatever they'd normally do!

 

[Meggiewoo]

I opted for a natural third stage and I haemorrhaged. Of course this may have happened with a manual third stage but I'm not going to risk it next time.........it was too scary!

Kim x x x x x

 

[sarah113]

natural with my 4 of my children, had injection with amber because of heavy blood loss with baby i lost

 

[hennaly]

mine was managed because of him being number 7 as apparenly you are higher risk of bleeding with the more you have.

 

[Sherlock]

I went the natural route and it was fine

We wanted to let the cord stop pulsing first before cutting and it never worried me that it would possibly take longer to deliver the placenta. I remember pushing mine out about 15 minutes after LO was born, I was lying down and pushed and nothing happened and so I squatted it and MW caught it in a dish

Baby gets the benefits from waiting for it to stop pulsing also

The not bleeding as much possibly aspect from not having an injection etc is maybe a plus. TBH though you bleed a fair bit after giving birth anyways so it again was not a concern for me. I had an average amount of blood loss the MW's told me, about 500ml. Then you continue to have blood loss for a number of weeks after giving birth.

Breast feeding is good for making the uterus start clamping back down and aiding healing and I did that also.

For me it was a very concious decision and although I was tired from giving birth I was happy to wait that little while to deliver the placenta natually (I didn't go through everything for a natural homebirth to then go have someine stick a needle in me afterwards ). I was never happy to just let MW's do as they wanted and made choices before hand and discussed with MW and she was more than happy to do as I wished. She actually would have done it the way I asked anyways as that is her normal policy unless informed otherwise

 

[daftscotslass]

I had the injection and ended up having to have a general anaesthetic to remove the placenta. They apply traction to the cord usually to and in my case it snapped leaving the placenta well and truly stuck - joy! Will go for a natural next time.

 

[uncle_bens]

It was less than 5 mins.

 

[*CLAIREBEAR*]

what an interesting thread!

i knew there was 2 options but did not know that there was risks etc with hemorraging (sp!?)with delivering it naturally as i have OC and will possibly be induced there is a risk of bleeding anyway,would i be better to go for the assisted method????

lol i am not very clued up! i never knew the cord pulsed??

 

[jools221181]

I didn't know all that and this is my 2nd!
I would like to do it naturally but the thought of higher blood loss puts me off a bit as I had to stay in longer last time after needed a blood transfusion and wouldn't want to risk that happening again.

 

[Sandi4Paul]

I did natural as it seemed right after a natural birth. My thinking was why have a natural labour and then an assited placenta delivery?? it came out after about 15 mins no hassel. My Oh got to cut the cord after it stopped pulsing.

I think Sherlock posted at the time i was close to popping that her midwife had said that yes there is more blood loss at the time, but then you bleed less in the weeks that follow. I did bleed loads in the hour or so after the birth (but not an amount to cause concern), but after 3 days was able to get rid of the maternity pads and move to sanitary pads (so much more discrete), and stopped bleeding completly after 3 weeks. I know that others in my NCT who had the injecion bleed for longer than this, but that may not be liked to the injection.

Sandi

 

[Sherlock]

what an interesting thread!

i knew there was 2 options but did not know that there was risks etc with hemorraging (sp!?)with delivering it naturally as i have OC and will possibly be induced there is a risk of bleeding anyway,would i be better to go for the assisted method????

lol i am not very clued up! i never knew the cord pulsed??

If you think about it the cord has been your babys lifeline while inside you It won't stop pulsing straight away as oxygen etc is still carried through it. Hence waiting till it stops pulsing and its totally finished its job.

As to the first part of your post, your best bet would be to discuss with your Consultant about it all.

I don't think the risks of bleeding are massive if someone delivers normally (and without pre exisiting medical condition). Just the injection causes things to happen in your body that would not normally, hence the bleeding being less. As I understand it women are more likely to bleed for longer in the days and weeks after giving birth with the injection. Without it, yes the bleeding is heavier to start but tends to slow and stop more quickly. I recall my bleeding stopping within 10 days or so pretty much and I had a natural delivery of placenta. Of course each woman is different and these things are not guarenteed to work, but that was my understanding from MW and reading etc

It is interesting to note that in the UK the guidelines state that a certain amount is to be considered average blood loss (I forget the amount now). But elsewhere on the continent it is much higher. If those numbers were recorded here for a woman then she would be considered as having had above average blood loss (hemorrhage). But in certain other countries it would be considered within normal peramiters. If that makes sense

 

[Sherlock]

I think Sherlock posted at the time i was close to popping that her midwife had said that yes there is more blood loss at the time, but then you bleed less in the weeks that follow. I did bleed loads in the hour or so after the birth (but not an amount to cause concern), but after 3 days was able to get rid of the maternity pads and move to sanitary pads (so much more discrete), and stopped bleeding completly after 3 weeks. I know that others in my NCT who had the injecion bleed for longer than this, but that may not be liked to the injection.

I am always surprised when people post and mention my name regarding something I've posted Nice to know people read my waffle

And yup, what my MW explained to me, I related here. Like you I bleed a bit heavily soon after birth but it soon slowed and more or less stopped after 10 days or so. I'll opt for natural again (so long as labour goes well etc) if we have another baby.

 

[Fluffy Bunny]

I did natural as it seemed right after a natural birth. My thinking was why have a natural labour and then an assited placenta delivery?? it came out after about 15 mins no hassel. My Oh got to cut the cord after it stopped pulsing.

Managed for me last time, although thats a really interesting way of looking at things. I never thought about the fact I'd gone for as natural labour as I could (birth pool and gas and air) yet was happy to have a managed placenta delivery. TBH although I had what I consider a pretty good labour with Evie by the time I'd birthed her I was just ready to shut my legs and be left alone. I knew from prior reading that natural delivery could take up to 30mins and I just wanted it over with so went with the injection.

Its something I need to think about for this time as theres a few things I want to do differently. Just out of interest, what were you girls who went for a natural delivery doing while you waited? Sorry to be a bit tmi but did you have to wait with legs open and being examined or were you left until you felt like it was coming (indeed, did you feel like you knew when it was on its way?)

 

[Sandi4Paul]

Its something I need to think about for this time as theres a few things I want to do differently. Just out of interest, what were you girls who went for a natural delivery doing while you waited? Sorry to be a bit tmi but did you have to wait with legs open and being examined or were you left until you felt like it was coming (indeed, did you feel like you knew when it was on its way?)
I had Logan on my chest whilst being in the same position as had given birth in, the midwife then rubs your tummy to help the placenta to come out. then the other midwife removed it as it came out (i hesitate to say caught it even though she kinda did, it makes it sound like it came shooting out whihc it didn't). I was mainly concentratimg om this new little person who was screaming blue murder (a sign of things to come).

I did feel it physically, but as i was just conentrating on Logan i didn't completly register it. I guess in same ways your still in that state (as i seemd to be for the whole labour) of my mind and body not being in the same place.

Sandi

 

[lisa282]

I had a bit of both really. With my first I had the injection as soon as he was born and delivered the placenta a couple of minutes later, it was really fast! With my second I had a waterbirth, and because of the water I couldnt have the injection on delivery so had to choose if I wanted to stay in the water and deliver the placenta naturally or get out and have the injection. As it turned out, I stayed in the water for 10 minutes or so getting to know my daughter and having a cuddle, by which time the cord had stoppped pulsating. So they cut her from me to do her checks and wrap her up while I got out of the pool, and we waited for the placenta...and waited. After 20-25 minutes it was showing no signs of coming, even though I was having strong contractions to expel it, and I just felt too numb to feel if I was pushing properly. Id been pushing since I got out of the pool, but it just wasnt happening, so after a while I asked for the injection to help me get it out. Within a couple of minutes I felt the midwife tug on it and it slid out without any trouble So I guess if it had come naturally within the half hour after birth, I would have kept it this way, but by then I just wanted to relax and hold my baby so I caved in and had some assistance. Anyway, my point is that you can kinda do it both ways, so the cord stops pulsating before you have the injection. They just generally do it as baby is delivered to get it over with as quickly as possible for mums benefit, but if you request that you want the cord to stop before they cut it, then Im sure they will accomodate you x

 

[Sherlock]

Its something I need to think about for this time as theres a few things I want to do differently. Just out of interest, what were you girls who went for a natural delivery doing while you waited? Sorry to be a bit tmi but did you have to wait with legs open and being examined or were you left until you felt like it was coming (indeed, did you feel like you knew when it was on its way?)

I had skin on skin with LO while I waited. Just laid down and held him cuddled on my chest and trying to root for my boob No one poked or prodded me down there while we were waiting. They popped a towel over me down there also. MW had had a quick look once LO appeared but didn't do anything else till the placenta was delivered. Then I was made comfy, stiched up, went and had a shower and got clean and came back and put LO back on my boob.

It really was fine and I'd opt for it again for sure.