Reply
 
LinkBack Thread Tools Search this Thread
Old Jul 17th, 2011, 14:04 PM   21
Eternal
Mum (Mom)
BnB Elite
 
 
Join Date: Jan 2009
Location: Swansea, Wales
Posts: 10,096
i had in my birth plan to delay cutting, you need to either not have the injection or delay it which can cause heavier bleeding, but everyone is different. My birth plan was all natural and i wanted a natural stage three unless there was an expended time (like over an hour) when i still havent delivered, although its quite normal for this to the case.

Anyway, in my case it didnt happen, i had to be transfered to hospital (from birth centre) and because my son had decreasing heart rate and myconium they needed to take him away for a little help when he was born, I was already pre-warned that he would need to be taken away so agreed to have the injection and clamp the cord quickly.

I wont be doing it this time as its twins, although if it were a single baby i would prob try again.



 
Status: Offline
 
Old Jul 17th, 2011, 19:49 PM   22
sarah1980
Mum (Mom)
Chat Happy BnB Member
 
 
Join Date: Sep 2010
Location: Scotland
Posts: 1,089
Quote:
Originally Posted by Connah'sMommy View Post
Thanks for all the great info ladies, This is definately something Ill be doing all being well

Just to get something clear though, i can have the injection once the cord is finally cut? Iv heard horor stories about some ladies who have declined the injection and bled quite alot....i know i prob shouldnt be listening to the horor stories but it still makes me wonder iykwim?

xx
I discussed this with my mw last week and she said "generally" she has found that ladies that don't have the injection bleed alot at the time of delivery then tend to have less bleeding in the weeks following delivery and that ladies that do have the injection bleed less at the time and more in the following weeks. This is just her observation though, I haven't researched it to see if there's anything to back it up.

She also said that when she delivers ladies that are looking to have a physiological third stage they can have the injection at any time so she gives the placenta time to come out on it's own but if she has any concerns she advises the lady that having the injection may be a good idea then takes it from there.

Hope that helps,

Sarah



 
Status: Offline
 
Old Jul 17th, 2011, 19:58 PM   23
Guppy051708
Mum (Mom)
BnB Spammer Elite
 
 
Join Date: Sep 2009
Location: U.S. Seacoast
Posts: 29,824
I found this VERY interesting article!!!! Love it. Basically what they describe happened to me (about having a water birth) you will see it. make sure you read it

http://midwifethinking.com/2010/08/2...ion-equipment/



 
Status: Online
 
Old Jul 18th, 2011, 02:51 AM   24
xSamanthax
Mum (Mom)
BnB Addict
 
 
Join Date: Jan 2011
Location: Halifax, West Yorkshire, UK
Posts: 5,458
I was recently thinking about this, still haven't made my mind up yet though



 
Status: Offline
 
Old Jul 18th, 2011, 21:02 PM   25
sarah1980
Mum (Mom)
Chat Happy BnB Member
 
 
Join Date: Sep 2010
Location: Scotland
Posts: 1,089
Quote:
Originally Posted by Guppy051708 View Post
I found this VERY interesting article!!!! Love it. Basically what they describe happened to me (about having a water birth) you will see it. make sure you read it

http://midwifethinking.com/2010/08/2...ion-equipment/


VERY interesting, thanks for sharing! I hope the midwives are co operative if I find myself in a similar situation.

Sarah



 
Status: Offline
 
Old Jul 19th, 2011, 20:56 PM   26
moodle
Trying to conceive (TTC)
Active BnB Member
 
Join Date: Jun 2011
Location: London
Posts: 197
Quote:
Originally Posted by Connah'sMommy View Post
Thanks for all the great info ladies, This is definately something Ill be doing all being well

Just to get something clear though, i can have the injection once the cord is finally cut? Iv heard horor stories about some ladies who have declined the injection and bled quite alot....i know i prob shouldnt be listening to the horor stories but it still makes me wonder iykwim?

xx
You may find this article helpful...

Further thoughts on the third stage
Sara Wickham

Taken from www.withwoman.co.uk

The third stage of labour has, for some time, been one of the hottest clinical topics in midwifery. Although both of the major research studies (1, 2) which have been carried out to compare the physiological birth of the placenta with active management suggest that the latter leads to less blood loss and 'better' outcomes, their findings have been challenged by many.

One of those taking issue with the research is Michel Odent, who suggests that it is impossible to compare the two types of management of the third stage without first understanding the positive steps we can take to facilitate physiological third stage (3). I would like to add another observation to this debate; the amount of blood loss in the hours following birth, which I believe may account for the differences reported in the above studies.

My observations arise from a time when I worked on a hospital postnatal ward, where women were admitted from the labour ward a couple of hours after they had given birth. Most of these women had had their third stages actively managed, and their recorded blood loss after the birth was usually around 100-200 ml. I would generally help these women to the bathroom the first time they felt they wanted to get up. Invariably, as I waited outside, women would call me in to inspect blood or clots which they had passed into the toilet or bedpan; they were often concerned about how much blood they had lost. Sometimes almost as much lochia was passed at this point as at the birth itself. Although I reassured the women that this was normal and there was no problem, the pattern started me thinking.

I realised that their blood loss was probably more noticeable to me because I had previously been practising in a situation in which the majority of women chose physiological third stage. After a physiological third stage, the women did not have the pattern of heavy bleeding delayed for a few hours after the birth that I was observing in the women who had had active management in the hospital.

It struck me that this might account for the different amounts of blood lost between women who had physiological and managed third stage. Could the use of an oxytocic inhibit the normal blood loss at birth, but cause the blood to be somehow retained by the woman's body and expelled later? This would account both for the difference in recorded blood loss at birth and the later loss of blood in women experiencing active management.

Physiologically, this would make sense. The use of an oxytocic drug causes a strong and sustained contraction of the uterus. The uterus is too well contracted to release a large amount of blood at this stage, which is why the blood loss is small in most cases. This is seen by many as “a good thing”, and cited as one of the advantages of using oxytocics in the third stage.

However, if the woman's body is physiologically adapted to losing more blood, it wouldn't be until the effects of the oxytocic had started to wear off that the uterus would be able to relax sufficiently to achieve this. So it may be that the average amount of blood lost during physiological third stage is “normal”, while the lesser amounts of blood lost during active management are abnormally low. If we recorded the amount of lochia lost in the first few hours after birth together with that lost during the birth itself, would the figures for the two types of third stage correlate more closely? Could it be that the total blood loss in women experiencing active management might actually be higher?

We also know that the administration of exogenous oxytocin inhibits the body's own production of endogenous oxytocin (4) which may be another factor in explaining this later blood loss. The effects of the oxytocic drug wear off before a woman's body has time to increase its own supplies of oxytocin to compensate. All midwives are aware of the need to consider the continuation of syntocinon for a while after the birth, because the woman's body may not be able to produce enough oxytocin to keep her uterus contracted. Does the same type of process happen when oxytocics are used in the third stage?

When comparing the outcomes of the two types of third stage, we tend to assume that “less is better”. But could it be that, for some women, the use of an oxytocic somehow inhibits the normal bleeding which is meant to occur at birth? Does this account for the slightly higher blood losses in women having physiological third stage? Why is it that, simply because women choosing physiological third stage may have higher blood loss initially, this is automatically viewed as pathological, when we may be causing the real pathology by our intervention in the process? We know that women's blood volumes increase during pregnancy, and some of this blood clearly needs to be released by the body in the first days and weeks after the birth.

Of course there are other issues; we need to understand more about how the third stage works physiologically and ensure we are employing the positive intercessions which assist this before attempting to compare physiological with active management. We need to be very clear about when the amount of blood loss is normal and when it becomes pathological; we also need to reflect upon what the causes of any truly pathological blood loss might be.

There are myriad aspects of the third stage which midwives need to consider and debate. Perhaps mine is an unusual experience, and others could add to these thoughts. The evidence which relates to this area needs to come from all sources; from midwives' experience and understanding of physiology as well as research trials. Whatever the answers may be, we do not yet have a complete enough picture for us to be able to fully inform the women we work with. And it is they who need to make the final decision about how their third stage will occur.


1. Prendeville W, Harding J, Elbourne D, et al. The Bristol third stage trial: active versus physiological management of the third stage of labour. BMJ 1988; 297:1295-1300.

2. Rogers J, Wood J, McCandish R, et al. Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial. Lancet 1998; 351:693-699.

3. Odent M. Don't manage the third stage of labour! The Practising Midwife 1998; 1(9):31-33.

Robertson A. The pain of labor. Midwifery Today 1997; 39: 19Š21, 40-42.



 
Status: Offline
 
Old Jul 19th, 2011, 21:00 PM   27
moodle
Trying to conceive (TTC)
Active BnB Member
 
Join Date: Jun 2011
Location: London
Posts: 197
And some videos too

http://academicobgyn.com/2011/01/30/...-grand-rounds/



 
Status: Offline
 
Reply



Bookmarks

Tags
clamping , cord , delayed

featured articles


Thread Tools Search this Thread
Search this Thread:

Advanced Search






SEO by vBSEO