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Old Oct 10th, 2016, 10:12 AM   1
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Active Management 3rd stage of Labor?

Has anybody had any experience with a birth plan that included an active management of the third stage of labor? I had never heard of this until recently. With my first, I hemmoraged pretty bad, and for this second baby, I've been doing all sorts of research on what can be done to prevent that this time around. I ended up speaking with a midwife and she suggested this - basically it entails medicine right after you deliver like Pitocin or Oxytocin to kick start the uterus contractions so it clamps down on the blood vessels. Has anybody had this done? I'm in the U.S. and my doc has never once mentioned this as an option- the only "assurance" they ever gave me was "well if you hemmorage, you'll be in a hospital so don't worry." That is not good enough for me! Any experience with AMTL, please share!

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Old Oct 10th, 2016, 10:54 AM   2
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If you've had a normal, straightforward natural birth (no induction, no assisted delivery, so a spontaneous birth with little to no intervention), it usually considered safest to have a natural physiological 3rd stage (no injection to help you deliver the placenta). Usually in this case, your body is doing fine producing its own oxytocin and there's no reason to intervene on what's working, except in cases where a PPH might be suspected (like if you've had a previous one). If you've had various sorts of intervention, including induction, it's often considered safer to have a managed 3rd stage with the injection. Induction alone increases your risk of PPH by 80% because all the synthetic hormones can lead to uterine atony, which is basically where your uterus gets too tired to contract down and expel the placenta because the synthetic hormones cause it to contract in a way it never would naturally. So often in those situations, it's considered best to intervene to head off any complications that could be caused by the intervention itself or just through the complications of a difficult labour.

With my first, I opted for a natural 3rd stage (no injection), but after about an hour, the placenta still wasn't coming and they were concerned about blood loss and the risk of a retained placenta, so I got the injection and it came about 25 minutes later. I had a home birth, so all perfectly natural and straightforward, and no complications or interventions, but my daughter was back to back, so I had a long drawn out pushing stage while she was turning. Everything was fine, but it just meant my uterus was more tired and worn out than it needed to be for the placenta to come on its own. We waited to see if it would, but when it didn't and I was losing some blood, I got the injection and it was fine. I lost about 550ml of blood, which is technically a small PPH, but not a serious one. I was fine. It was never an emergency situation of any sort. The injection sorted it out and all was well. I plan to have another home birth next time and likely won't opt to have the injection right away, as for me, I think it makes sense in the context of an otherwise easy, natural birth, no to then intervene at the end unless there is a reason to. But you can always decide in the moment and get it. Usually if you decide in advance, they'll cut the cord very quickly and give you the injection. That's important if you genuinely need it, but it does mean you lose the chance for optimal cord clamping, so your baby loses blood and is at more risk of anemia. But you can always request to wait a few minutes, have some skin to skin, let all the blood drain back from the placenta to baby and see if it's coming and how you feel, and then if you need it, cut the cord and get the injection then. I waited an hour and all was fine, so there isn't a rush if you want to wait and see, but at the same time, yes, it's a very standard thing to do, especially in situations where there has already been intervention (like with induction) or where there were other complications, and in those cases, it can be the safest approach. It's just a matter of balancing what you feel your body needs in the moment, your wishes for optimal cord clamping and some hands off time after birth, and just what you feel comfortable with. It may be you find it reassuring to know you can minimise the risk of another PPH and that will make the whole experience more pleasant without it weighing on your mind while you're giving birth.

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Old Oct 10th, 2016, 18:20 PM   3
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Are you sure you wouldn't have had an active managed third stage previously? It's the normal procedure here in Australia unless you specifically ask for it (and even then they still usually do it out of habit) and I know so many American women who have had active third stages without even realising (my understanding is the consent forms are usually filled out pretty early with very little explanation of what they actually entail)

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Old Oct 14th, 2016, 06:24 AM   4
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I wish I'd had it sooner last time as I had quite a big bleed! If you have haemorrhaged before it's definitely a good plan (if it was due to atonic uterus). I also have a clotting disorder so will be having it 100% this time to avoid losing so much blood.

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Old Oct 19th, 2016, 09:25 AM   5
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I was given pitocin after an unmedicated birth to speed up placenta delivery and stem bleeding. At that point I didn't care much because I had my baby in my arms. I also had a 3rd degree tear and needed stitching as well. I'm not sure if the pitocin made the after birth pains any worse. It wasn't anything that I heard about in advance and I'm not sure how long they waited to give me the pitocin. It's kind of a blur.

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Old Oct 31st, 2016, 04:26 AM   6
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I had a retained placenta with my first baby so now with my second I've been advised that they will commence me on a drip of...syntocin or something like that lol as soon as baby's out in order to reduce the likelihood of having to go to theatre again. However they said if I do haemorrhage badly only choice is theatre. I'm in the UK so might be different?

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Old Nov 1st, 2016, 16:13 PM   7
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I'm in the UK and in my hospital it's standard to have the shot as soon as baby is out, I do remeber them saying right do you want this...I was induced both times tho so maybe that was it, as it stands tho I will do it again this time, it hadn't even crossed my mind that birthing the placenta was an important stage haha as mine always came away within 15 mins, was whole with less than 300ml blood loss,

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Old Nov 9th, 2016, 13:17 PM   8
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It's def standard practice to give the medicine after birth in the UK. From my experience on a maternity ward, the midwives all rolled their eyes at those choosing non medicated 3rd stages! I guess it made their jobs harder as it takes longer! The only thing I noticed about it negatively was it made people feel pretty nauseous or actually sick. I had the joy of fetching the sick bowls (work experience skivvy). But anti-sickness was usually offered to these women!

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Old Nov 16th, 2016, 03:38 AM   9
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I had massive PPH after my first and none of the needles they gave me (3 kinds) stopped the bleeding so I was sent to theatre.

I was concerned about a repeat for my 2nd and discussed my concerns with my OB. He said that just like every pregnancy is different, so too the delivery and that PPH might not happen again. We talked about it and I decided to go on a drip straight after delivery and I'm glad I did for peace of mind more than anything else. I just focussed on my baby and the drip was in the back of my hand so no dramas at all.

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Old Nov 16th, 2016, 04:00 AM   10
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All 3 times had it really soon after birth. No isses and my blood loss was 110ml so tiny x

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