# physiological or managed third stage???



## winegums

just thought i'd sum up some pros and cons for people trying to decide (seen a couple of threads about it)

*Physiological (natural)*

Can take up to an hour or in some cases 2 hours :shock: (however studies have shown that it is on average around 10 minutes longer than if given drugs)
Mummy needs to do some work (usually) - pushing placenta out
On average blood loss after the birth is higher!
You can wait a while before having the cord clamped and cut (if this is your choice, if not you can still have the cord cut straight away)
You generally get more skin to skin contact immediately after the birth cuddling baby while waiting for placenta

*Managed third stage*

Placenta comes out quickly, usually within 5 or 10 minutes
Mummy doesn't have to do any work the drug forces the uterus to push the placenta out
On average there is less blood loss
Some people have side effects from the drug such as sickness, dizzyness etc which can stop the mum being able to hold her baby straight away (less skin to skin etc)
Can cause blood pressure changes in women too (low bp = faintness etc)
In rare extremely rare i hope cases the uterus can contact and tighten up before the placenta gets out (or something like that) and it becomes trapped and needs to be surgically removed!!! :nope: but of course thats not common at all other wise they wouldnt give the drug!

p.s. obviously if you choose to have a natural but it is taken a really long time or there is a lot of blood loss then you can have the injection!

also if anyone has any corrections, or anything to add etc let me know but just trying to help people as i have been trying to find out about it for myself!


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## flubdub

Thanks for this. I wasnt going to have the injection to help the placenta out this time, as with both of my children, straight after giving birth, I have been constantly throwing up for 2/3hours, which is awful because I cant hold the baby etc. I always put it down to the injection as I have always felt fine _before_ it. I dont know what to do now, and will speak to my midwife to see why she thinks I am always sick.
I didnt know about the blood loss, or that it is the drug that pushes the placenta out, so thankyou very much :flower:


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## kiwimama

Thanks for that hun! :flower: I had a managed 3rd stage last time as there could have been complications with blood loss if I hadn't. Luckily it didn't make me sick at all and held my baby all the way through. I don't remember ever even needing to push and didn't feel it come out. Perhaps I was just engrossed in my new baby!


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## bubbles

The injection made me so sick last time so will be going au natural this time, hopefully with the help of baby and DS nursing


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## Rmar

Hey, thanks for adding this. It is great information.

Hope you don't mind but I would like to add something I found from this site about the third stage.



> *Third Stage*
> 
> 
> The third stage of labour refers to the period following the completed delivery of the baby until the completed delivery of the placenta.
> 
> Active third stage
> 
> The delivery of the placenta through the use of drugs or manual removal is know as the active management of the third stage of labour. An injection of syntocinon or syntometrine is given intramuscular into the mother directly after the baby is born and the umbilical cord is also clamped and cut at this time.
> 
> Most hospitals will actively manage the third stage unless you inform them that you want a natural third stage. Ensure that if you do choose a natural third stage that adequate time is provided for you to birth the placenta naturally.
> 
> Natural third stage
> 
> The cord is left attached to the placenta and baby until it stops pulsating or longer. The mother delivers the placenta naturally with the use of contractions and/or gravity.
> Positives of active management
> 
> * Reduce risk of hemorrhaging
> * Speed up delivery of placenta
> 
> 
> Negatives of active management
> 
> * Powerful contractions that can trap the placenta, if this happens you will need to go to surgery to have it removed and be separation from your baby.
> * Increased nausea, vomiting and hypertension in the mother
> * Cord is cut/clamped early so the baby doesnt receive the valuable cord blood.
> 
> Disadvantage of early cutting/clamping of the umbilical cord
> 
> * It is estimated that early clamping deprives the baby of 54 to 160 ml of blood, which represents up to half of a babys total blood volume at birth.
> * There is a significant amount of iron in the cord blood that the baby needs for optimal health and for the prevention of anemia.
> * The earlier the cord is clamped, the more likely the incidents of respiratory distress syndrome in the baby.
> * The blood that babies receives through the cord after birth acts as a source of nourishment that protects infants against the breakdown of body protein.
> 
> The recent discovery of the amazing properties of cord blood, and in particular the stem cells contained within it, should show us how important this blood is to our new born baby!
> 
> Source https://birthbliss.wordpress.com/20...ping-of-the-umbilical-cord-in-newborn-babies/
> 
> It is more important that the placenta detach easily than that it emerge quickly, the less risk of hemorrhage.  Michel Odent
> 
> Suggestions
> 
> * Choose a care provider who trusts in the natural process of the third stage and have the skills to assist if something arises.
> * Delay cord clamping
> * Have skin to skin
> * Give yourself time to deliver your placenta
> * Follow suggestions from your care provider such as standing up, squatting, coughing, and/or blow into the neck of a bottle
> * Birth the placenta naturally with contractions caused from the rush of oxytocin that is released from contact with her baby as well as breastfeeding.
> 
> Lotus Birth
> 
> *
> Lotus Birth of Phoenix
> 
> Lotus Birth of Phoenix
> 
> Lotus Birth is the practice of leaving the placenta/cord attached to the baby after birth, until it separates naturally 3-10 days later (as per cut cord).
> * The placenta is naturally birthed 20-60 minutes after the baby.
> * Baby gets 40-60 ml of blood from placenta if cord if not tied until pulsation ceases. (30ml to newborn is equivalent to 600ml in adult).
> * At a minimum, placenta should be left intact until it stops pulsing  20-60 minutes after birth.
> * First voices heard and faces seen by the baby should be the mother and father, the first 45 minutes of babys life is crucial for flow of oxytocin  important to babys neurological development and well-being.
> * Lotus Birth slows things down  time to reflect and settle in together. The first few days see the digestive tract and the elimination system, both of which are part of placental function, become established in the babys body.
> * Blood/oxygen in placenta/cord supports babys new breathing/lung process so it is less traumatic. The transfer of important stem cells from cord blood should be allowed to flow to babys bone marrow after birth, transforming into various types of blood-making cells.
> 
> The Placenta
> 
> * Placenta means flat cake/flat plate.
> * Yearly birthday celebrations with cake is reminiscent and referencing of our birth and sacred placenta.
> * Same foetal genetic material splits into 2  one becomes the baby and the other the placenta. The mother births a baby-placenta unit.
> * The placenta is an organ of high intelligence  has its own metabolism, regulates maternal functions, separating blood circulations etc. It establishes during first 10 weeks and is fully mature by 3 months  feeding the baby and carrying away waste.
> * The placenta supports the babys immature liver in unloading toxins and drugs received during birth. It also allows for flow of oxytocins instead of adrenaline. Even after blood/waste transference is completed, there is flow of life force, completing the babys aura. Auras of Lotus Birth babies are whole and strong, compared to those there the cord was cut.
> 
> Caring for the Placenta
> 
> 1. Allow placenta to be born naturally (without oxytocins and pulling).
> 2. Place it in bowl near the baby. Keep level with baby until blood transfusion is completed.
> 3. Within 2-3 hours wash placenta in warm water to remove clots and pat dry.
> 4. Wrap it in absorbent material (towels, nappy or cloth), salt it (rock salt) and place in colander, set inside larger bowl, to drain for 24 hours.
> 5. Change towels and reapply the salt each day, keeping as dry as possible.
> 6. After 3rd or so day, when it is no longer seeping liquid, wrap in new absorbent cloth and pace in placenta bag (fabric, not plastic).
> 7. Resalt and wrap in fresh towels as required to preserve and eliminate odours.
> 8. Allow cord to disconnect from baby naturally, in its own time.
> 9. When cord is dry, you can wet to soften and reshape if required.
> Source: Lotus Birth, Shivam Rachana, https://www.humantransformation.com.au/html/publicationslotus.html

This Quote is sources from the MyBirth website (https://www.mybirth.com.au) who give great information on most types of intervention.


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## goddess25

Great topic i had planned on a pain med free natural birth in all stages... but ended up in theatre getting him pulled out with forceps (I was prepped for c-section and they had one last try) i had a spinal, a catheter, an IV and they gave me the drug to help expel the placenta. I had lost too much blood plus they needed me out of the theatre. 

Next time I still plan on the no pain med thing as i managed up until i had to go into theatre and i am not sure what my thoughts are in regards to the injection this time. I did feel sick last time but i put it down to the spinal anesthetic. I am planning on a home birth so I guess i will talk it over with my midwife.


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## flubdub

SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.


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## Rmar

Most people who have described their third stage experience say they don't even notice it. From an onlookers point on view, it seems as most women I have seen are paying so much attention to their newborn and don't do much focused pushing. I haven't experienced this myself so I can't comment on what it feels like, just an observation.


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## winegums

flubdub for many people it literally drops out hehe! especially those having a water birth, they get out to deliver the placenta (in most cases) and as they reach their legs over the side of the pool it is quite common to drop out.

It helps to get the placenta out also by breastfeeding, or having baby suck nipples etc lol also when the baby is laying on your belly but the midwife can rub your belly to stimulate the baby being on it which also helps you contract pushing the placenta out

generally its not too much work many women hardly notice it, it's usually one or too pushes and it plops out. Sometimes you feel a contraction then an uncomfortable feeling inside (the placenta is on the cervix) and if you wiggle around / squat etc it should come out!

Rmar thanks for the extra information! very good info on cord blood... i forgot about the lotus birth!! dont think i'd ever be doing that :/

xx


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## flubdub

winegums said:


> flubdub for many people it literally drops out hehe! especially those having a water birth, they get out to deliver the placenta (in most cases) and as they reach their legs over the side of the pool it is quite common to drop out.
> 
> It helps to get the placenta out also by breastfeeding, or having baby suck nipples etc lol also when the baby is laying on your belly but the midwife can rub your belly to stimulate the baby being on it which also helps you contract pushing the placenta out
> 
> generally its not too much work many women hardly notice it, it's usually one or too pushes and it plops out. Sometimes you feel a contraction then an uncomfortable feeling inside (the placenta is on the cervix) and if you wiggle around / squat etc it should come out!
> 
> Rmar thanks for the extra information! very good info on cord blood... i forgot about the lotus birth!! dont think i'd ever be doing that :/
> 
> xx

Do you mean all that for if you _havnt_ had the injection? I had the injection with my first two, and the placenta never bothered me - never pushed or anything. But I really dont want the injection this time as I spend hours throwing up afterwards and cant even hold the baby.


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## Rmar

The throwing up afterwards is most likely due to a reaction with the injection. The injection is synthetic oxytocin. Oxytocin is produced by the body in great amounts straight after birth, mostly a lot more in a drug free birth(but not always in some women), which stimulates the placenta to come out and reduce bleeding and also gives feeling of love and that elated feeling. Its natures way of making sure we bond with our little ones (not that it isn't possible, otherwise). 

If you don't have the injection there are a few ways to naturally bring on more oxytocin like skin to skin contact with the baby and breastfeeding. It will most likely take longer for the placenta to be released without the injection but it shouldn't be any harder for it to be expelled.

Talk to your care provider about how you felt after the injection and what you can do this time to have a physiological 3rd stage.


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## winegums

yeh flubdub if you DONT have the injection the placenta may still come out without you hardly noticing however some people have either 1 or 2 contractions and it comes out.
its not like giving birth it may be a while before the placenta is ready to be pushed out but when it is it only takes a min!


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## alio

i had managed 3rd stage last time and even with a spinal block i can still feel the sensation of them pulling my placenta away. it makes me feel sick to think of that single experience. i have requested physiological this time although i am totally open to having it managed again providing it is in my best interests.


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## lynnikins

I had a managed 3rd stage with my first and ended up with some PPH and was bleeding for 7wks heavily post birth

with my second i had a natural 3rd stage and it took about 20 min after he was born for the placenta to arrive i got 2-3 urges to push and easily pushed it out, the cord wasnt cut till it had stopped pulsating and EJ was laid on my chest till the cord was cut and allowed to nurse then after over an hour was taken and my DH got a cuddle then he was given back to me to nurse while they stiched up my tear.

I will definatly have a natural 3rd stage with any other children and keep all pain relief to a minimum during the labour and birth ( coped on just Tens and water in labour and G&A for the birth with both boys ) and i had less bleeding post birth with EJ


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## Mervs Mum

flubdub said:


> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.

I had a physiological 3rd stage and we agreed to play it by ear if the MW thought managing it would be helpful with blood loss. The cord pulsed for exactly 10 mins at which point the MW said 'try a gentle push' and out slithered the placenta. My lochia stopped after 5 days.....another welcomed side effect!


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## flubdub

Mervs Mum said:


> flubdub said:
> 
> 
> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> I had a physiological 3rd stage and we agreed to play it by ear if the MW thought managing it would be helpful with blood loss. *The cord pulsed for exactly 10 mins *at which point the MW said 'try a gentle push' and out slithered the placenta. My lochia stopped after 5 days.....another welcomed side effect!Click to expand...

Why do midwives not wait for it to stop? I feel bad that I never did with my two kids, but I also didnt know about it! I will definately ask for them to wait with this baby, but I would rather that it was just what was done anyway.


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## Mervs Mum

flubdub said:


> Mervs Mum said:
> 
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> flubdub said:
> 
> 
> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> I had a physiological 3rd stage and we agreed to play it by ear if the MW thought managing it would be helpful with blood loss. *The cord pulsed for exactly 10 mins *at which point the MW said 'try a gentle push' and out slithered the placenta. My lochia stopped after 5 days.....another welcomed side effect!Click to expand...
> 
> Why do midwives not wait for it to stop? I feel bad that I never did with my two kids, but I also didnt know about it! I will definately ask for them to wait with this baby, but I would rather that it was just what was done anyway.Click to expand...

No you're mis reading that - it *DID *stop of it's own accord - I'm just saying it was only 10 mins for my whole natural 3rd stage! There's no way I would have cut it or stopped it pulsing. We waited and it stopped after 10 mins at which point the MW asked me to try a little push :)


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## Blob

I had the injection last time and still had to push it out :wacko: Do you think this will make a difference if i dont have one this time?? 

I really want to let the cord stop pulsating, but can you have the injction after :lol:


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## flubdub

Mervs Mum said:


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> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> I had a physiological 3rd stage and we agreed to play it by ear if the MW thought managing it would be helpful with blood loss. *The cord pulsed for exactly 10 mins *at which point the MW said 'try a gentle push' and out slithered the placenta. My lochia stopped after 5 days.....another welcomed side effect!Click to expand...
> 
> Why do midwives not wait for it to stop? I feel bad that I never did with my two kids, but I also didnt know about it! I will definately ask for them to wait with this baby, but I would rather that it was just what was done anyway.Click to expand...
> 
> No you're mis reading that - it *DID *stop of it's own accord - I'm just saying it was only 10 mins for my whole natural 3rd stage! There's no way I would have cut it or stopped it pulsing. We waited and it stopped after 10 mins at which point the MW asked me to try a little push :)Click to expand...

Sorry, I must have worded it stupidly. I knew what you meant. I meant, why, in hospitals, do midwives clamp and cut straight away? Why dont they wait until it has finished pumping?


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## JenStar1976

flubdub said:


> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.

Sorry if a bit gross, but I would liken the sensation to perhaps pulling out a Super Plus Tampax!!! So, not painful at all - you don't have to strain to push like you do when birthing your baby. It's just a slight push (like when you poo!!).You can feel that something is coming out, but as the placenta is completely soft, it does just slip out! Again, sorry ladies if this has sounded grim! But hey, once you've had a baby, you tend to talk about all of this quite matter-of-factly! x


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## Mervs Mum

flubdub said:


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> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> I had a physiological 3rd stage and we agreed to play it by ear if the MW thought managing it would be helpful with blood loss. *The cord pulsed for exactly 10 mins *at which point the MW said 'try a gentle push' and out slithered the placenta. My lochia stopped after 5 days.....another welcomed side effect!Click to expand...
> 
> Why do midwives not wait for it to stop? I feel bad that I never did with my two kids, but I also didnt know about it! I will definately ask for them to wait with this baby, but I would rather that it was just what was done anyway.Click to expand...
> 
> No you're mis reading that - it *DID *stop of it's own accord - I'm just saying it was only 10 mins for my whole natural 3rd stage! There's no way I would have cut it or stopped it pulsing. We waited and it stopped after 10 mins at which point the MW asked me to try a little push :)Click to expand...
> 
> Sorry, I must have worded it stupidly. I knew what you meant. I meant, why, in hospitals, do midwives clamp and cut straight away? Why dont they wait until it has finished pumping?Click to expand...


I think it depends on your area - I had my second baby in a birth centre attached to a hospital and they let the cord pulse there too. It's crazy that they dont leave it to pulse as standard though I agree. Cutting it before all the blood has passed across it is effectively like the baby hemorrhaging....ie they are missing part of their new blood supply.


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## flubdub

JenStar1976 said:


> flubdub said:
> 
> 
> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> Sorry if a bit gross, but I would liken the sensation to perhaps pulling out a Super Plus Tampax!!! So, not painful at all - you don't have to strain to push like you do when birthing your baby. It's just a slight push (like when you poo!!).You can feel that something is coming out, but as the placenta is completely soft, it does just slip out! Again, sorry ladies if this has sounded grim! But hey, once you've had a baby, you tend to talk about all of this quite matter-of-factly! xClick to expand...

So its not going to be much different from the two times I have had the injection? Im really worrying about it already, more so than giving birth, because it goes on for hours and I cant hold the baby :(


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## Mervs Mum

flubdub said:


> JenStar1976 said:
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> flubdub said:
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> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> Sorry if a bit gross, but I would liken the sensation to perhaps pulling out a Super Plus Tampax!!! So, not painful at all - you don't have to strain to push like you do when birthing your baby. It's just a slight push (like when you poo!!).You can feel that something is coming out, but as the placenta is completely soft, it does just slip out! Again, sorry ladies if this has sounded grim! But hey, once you've had a baby, you tend to talk about all of this quite matter-of-factly! xClick to expand...
> 
> So its not going to be much different from the two times I have had the injection? Im really worrying about it already, more so than giving birth, because it goes on for hours and I cant hold the baby :(Click to expand...

I dont understand what you mean? Why couldnt you hold the baby?


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## flubdub

Mervs Mum said:


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> JenStar1976 said:
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> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> Sorry if a bit gross, but I would liken the sensation to perhaps pulling out a Super Plus Tampax!!! So, not painful at all - you don't have to strain to push like you do when birthing your baby. It's just a slight push (like when you poo!!).You can feel that something is coming out, but as the placenta is completely soft, it does just slip out! Again, sorry ladies if this has sounded grim! But hey, once you've had a baby, you tend to talk about all of this quite matter-of-factly! xClick to expand...
> 
> So its not going to be much different from the two times I have had the injection? Im really worrying about it already, more so than giving birth, because it goes on for hours and I cant hold the baby :(Click to expand...
> 
> I dont understand what you mean? Why couldnt you hold the baby?Click to expand...

Oh sorry I missed it out of my last post! :dohh: Its because I was constantly being sick which I think the injection caused.


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## JenStar1976

flubdub said:


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> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> Sorry if a bit gross, but I would liken the sensation to perhaps pulling out a Super Plus Tampax!!! So, not painful at all - you don't have to strain to push like you do when birthing your baby. It's just a slight push (like when you poo!!).You can feel that something is coming out, but as the placenta is completely soft, it does just slip out! Again, sorry ladies if this has sounded grim! But hey, once you've had a baby, you tend to talk about all of this quite matter-of-factly! xClick to expand...
> 
> So its not going to be much different from the two times I have had the injection? Im really worrying about it already, more so than giving birth, because it goes on for hours and I cant hold the baby :(Click to expand...
> 
> I dont understand what you mean? Why couldnt you hold the baby?Click to expand...
> 
> Oh sorry I missed it out of my last post! :dohh: Its because I was constantly being sick which I think the injection caused.Click to expand...

How long after you gave birth did they decide to give you the injection? Did the midwives wait to see if you could deliver naturally? Not sure, but can the injection stall things a bit? It took 12 minutes for me to deliver the placenta naturally. x


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## Mervs Mum

I think they can administer it any time really - or so my MW told me. we decided to have the injection on stand by as it *can* help if you bleed more than they'd like you to :)


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## flubdub

JenStar1976 said:


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> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> Sorry if a bit gross, but I would liken the sensation to perhaps pulling out a Super Plus Tampax!!! So, not painful at all - you don't have to strain to push like you do when birthing your baby. It's just a slight push (like when you poo!!).You can feel that something is coming out, but as the placenta is completely soft, it does just slip out! Again, sorry ladies if this has sounded grim! But hey, once you've had a baby, you tend to talk about all of this quite matter-of-factly! xClick to expand...
> 
> So its not going to be much different from the two times I have had the injection? Im really worrying about it already, more so than giving birth, because it goes on for hours and I cant hold the baby :(Click to expand...
> 
> I dont understand what you mean? Why couldnt you hold the baby?Click to expand...
> 
> Oh sorry I missed it out of my last post! :dohh: Its because I was constantly being sick which I think the injection caused.Click to expand...
> 
> How long after you gave birth did they decide to give you the injection? Did the midwives wait to see if you could deliver naturally? Not sure, but can the injection stall things a bit? It took 12 minutes for me to deliver the placenta naturally. xClick to expand...

I cant really remember with my first child, but with nymber two, I think it was quite literally _just_ as he was coming out. No, there was no talk of seeing if I could do it naturally. Cord was cut straight away too, which Im quite sad about now.


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## Mervs Mum

:( :hugs:


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## winegums

in most trusts they ask you if you want the injection.. talk about the side effects of not having the injection so that the women usually chooses to have it! then they clamp and cut the cord straight away, though some places are starting to wait a couple of minutes first... if that's any consolation lol a measly 2 minutes.

the reason the cord is clamped and cut so soon for the majority of women... is because the majority of women have a managed third stage, not natural. they need to cut the cord to stop the drug going to the baby!

also generally eaasier and more conveniant for midwives. for example how society is nowadays if they left the cord to pulse for longer there can be complications (too much bleeding, pph, jaundice etc) HOWEVER the benefits of cord blood greatly outweight the risks (in most peoples opinions) but you know what people are like these days they would be very quick to blame the midwives if anything happened so in general the third stage is managed unless the mother asks for physiological third stage.

guess thats what birth plans are for!


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## milkmachine

i didnt have a managed stage with my last baby, the placenta came out very easily although they were getting ready to inject due to blood loss. I also didnt bleed for as long after although i cant remember exactly how long, i remember heavily bleeding for no more than a few days then just brown discharge for a few days. none of this bleedng for 6weeks lark


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## cupcake23

flubdub said:


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> SO how much work is involved if you DONT have the injection? After pushing a baby out, I dont know if I want to carry on pushing afterwards, but like I said before, Im pretty convinced that injection makes me very very sick.
> 
> Sorry if a bit gross, but I would liken the sensation to perhaps pulling out a Super Plus Tampax!!! So, not painful at all - you don't have to strain to push like you do when birthing your baby. It's just a slight push (like when you poo!!).You can feel that something is coming out, but as the placenta is completely soft, it does just slip out! Again, sorry ladies if this has sounded grim! But hey, once you've had a baby, you tend to talk about all of this quite matter-of-factly! xClick to expand...
> 
> So its not going to be much different from the two times I have had the injection? Im really worrying about it already, more so than giving birth, because it goes on for hours and I cant hold the baby :(Click to expand...
> 
> I dont understand what you mean? Why couldnt you hold the baby?Click to expand...
> 
> Oh sorry I missed it out of my last post! :dohh: Its because I was constantly being sick which I think the injection caused.Click to expand...
> 
> How long after you gave birth did they decide to give you the injection? Did the midwives wait to see if you could deliver naturally? Not sure, but can the injection stall things a bit? It took 12 minutes for me to deliver the placenta naturally. xClick to expand...
> 
> I cant really remember with my first child, but with nymber two, I think it was quite literally _just_ as he was coming out. No, there was no talk of seeing if I could do it naturally. Cord was cut straight away too, which Im quite sad about now.Click to expand...

If you choose not to do it naturally ask that they give you syntocinon IM instead of syntometrine. Syntometrine has a nasty side effect of raising your blood pressure very quickly causing you to became nauseous and sick. With ds I did active management, about 30 mins later I was vomiting every where, not nice!

With Mya I had a physiological 3rd stage, it lasted about 20mins, after the cord stopped pulsating it was clamped and cut and all I had to do was stand up and it literally fell out. Blood loss for both births were minimal.


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## Mervs Mum

Sorry Cupcake but the little image of you stood up and it falling out did make me giggle! :lol:


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## silver_penny

The reason the midwives clamp and cut with a managed third stage: When the artificial oxytocin is administered, it causes unusually strong uterine contractions. These contractions cause an increase of blood pressure flowing through the cord to the baby, In order to prevent this unnaturally fast increase in blood pressure and volume in the newborn, the cord is clamped and cut.

In a physiological thrid stage, the gentle uterine contractions stimulate gentle blood flow from the placenta to the baby, and the baby's vein is allowed ample time to regulate blood pressure, blood flow, and volume. As the placenta shrinks, it falls away naturally from the uterine wall. If the cord is not cut, the placenta is significantly smaller, and you won't have as much risk of it being too big to come out through the cervix.

With my first, I had a managed third stage (against my will, I told the stupid people I didn't want the injection, and they said "Oh, we have to." grrr :growlmad:). I bled for an entire 6 weeks! This time (if I end up in the hospital), I will not allow them to go against my wishes. If they give me adequate reasons for a managed third stage, I will consider it, but if I don't give my consent and they proceed to do it anyways, they will find themselves with a very nasty lawsuit! /rant


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## goddess25

I am going to mention this when i see my midwife i am hoping for a home birth and i think i like the sound of a natural third stage..


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## winegums

ohh thats a good point about the bleeding! though the bleeding may be more at the time after birth... in the weeks to follow it is significantly less if you didn't have the jab. so it all evens out in the end! lol xx


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## summer rain

Hi

I had a managed third stage with all of mine; for various medical reasons (such as I always need stitches after each birth due to fast labours and unforseen circumstances such as the baby having both hands on his face; and they have to be done quite soon after in my case). They always asked for my consent and gave me the option of not having it but I just ended up doing so. I'll keep an open mind this time but if I have a very large placental site again and need stitches I'll just go for the injection. 

Soph x


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## cupcake23

Mervs Mum said:


> Sorry Cupcake but the little image of you stood up and it falling out did make me giggle! :lol:

The joys of giving birth!:winkwink:


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## Mervs Mum

hehe :lol: It's weird when it comes out isnt it.....but the feeling when the body slithers out is unmistakable....I was waiting for it with Sidney.....I LOVE that weird sensation...


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## Pops

This has been an interesting read for us as we haven't been totally decided up until now.....thanks ladies :hugs:

xxx


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## wiiwidow

This is all really interesting, I've got a while to go yet but I didn't realise there were different options for the 3rd stage. (Didn't even know much about the 3rd stage!) So this has been really useful, thank you! At least I now know when I make the choice it will be a little bit more informed! :thumbup:


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## Mervs Mum

The fab thing when you have a great MW like you do Pops is that you really can play the whole thing by ear. I said I didnt mind which way we went and the MW said 'let's just see how it pans out' We did and even as we sat chatting while the cord pulsed I remember asking if there was a cut off to when they can give the syntometrine and she said 'not really although some would have you believe there is....' my blood loss was acceptable and the placenta came away easily with no help at all. It makes sense that if it's 'empty' and thinks it's work is done, it will want to let go given the time. There's no rush. :)


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## wiiwidow

Can I ask does it make any difference if you've had an epidural or something like that? Or can you still do it naturally?


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## Mervs Mum

good question but you wouldnt have an epidural at home though would you.....


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## winegums

no but you can have a physiological third stage in hospital if you ask for it!


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## wiiwidow

I was just thinking of worst case scenarios and just wondering even if for whatever reason you ended up in hospital having an epi could you still have the 3rd stage you wanted? Am very new to this so just asking... Hope that's ok? x


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## Mervs Mum

Of course it is! :D If you did end up transferring and there was no reason not to have a physiological 3rd stage I'm sure it would be fine. I imagine in most cases if you transfered as an emergency you might not be too concerned about the 3rd stage though.


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## winegums

True, wiiwidow if your transfered they may end up giving you a c section or something (they like to do them a lot for some reason lol!!). Or other complications which mean that the last thing on your mind will be the third stage. Make sure you think about it all in advance what you would / wouldn't do in certain situations and make your midwife aware and write it on your birth plan.


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## wiiwidow

Very true! I guess your point about making sure it's in my birth plan and that they know my wishes is a good one. I guess I was just thinking if all else went to pot (don't know why I'm all negative tonight) it would be good if you could still get that last bit. It seems quite important to me! Thanks both :) xx


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## Mervs Mum

I agree - if it's in your plan and you do end up in hospital it's important to feel like you still have some control over things :)


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## TeresaG

This thread has been interesting as I haven't quite decided about this yet.


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## madasa

I think all the faffing about they do counters the effect of the drug and stalls the placenta for some women... maybe that is what happened to me. Regardless of which you choose, insist on a quiet environment and as much skin to skin and feeding as possible, as few people in the room as possible, and for anyone who does stay with you to keep a low profile....

STAY WARM. Tell DH in advance that after the baby is born he needs to turn the heating up or put a blanket round you or something. I've been reading a lot of Michel Odent stuff (who is on Facebook apparently! :) ) and keeping warm helps reduce your blood loss....


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## hotpinkangel

Hi, i have had the injection with my first child, and my placenta came away with 'ragged' edges, i was passing clots for 3 days, with my second child i had a water birth and a physiological 3rd stage, where my placenta came away complete, and it didn't take too long, maybe 5 -10 mins? i had to push twice i think, then it pretty much dropped out.


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## silver_penny

Oh, and if you keep warm, it helps your body release oxytocin, the natural hormone that helps your uterus contract and placenta fall away. It also aids in the bonding process with your LO.


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