3rd stage in water = risk of embolism? Anyone delivered a placenta in water?

[allaboard]

I'm having a home water birth (if i can, as there are staff shortages grrrr!), and my MW said i need to get out for delivering the placenta otherwise there is risk of a water embolism.

I hear now that this statement isn't significantly backed up by research at all. I understand that i must keep the water at 36.5 degrees or above to reduce risk of the cervix clamping and having a retained placenta.

Have any of you delivered the placenta in the water? i really don't want to get out and reduce my body temp, unless necessary or i want to when the time comes.

 

[wigglywoo]

Never heard of that

About the staff shortages, have a look on https://www.aims.org.uk/homebirthUpdated.htm#bookingAHomeBirth and get writing to the people they suggest (if you haven't already). Telling women that they are short staffed is apparently a common tactic employed from around 37 weeks to try and get women to 'comply' and go into hospital.

 

[Tegans Mama]

If you call and say you're in labour and staying at home, they can't refuse to attend you anyway, so ignore the short staffed comments

I've never heard of a water embolism either... I'm sure someone will come along with some good advice though

 

[chuck]

Ad far as I know it is preferred you get out for the 3rd stage so the MW can better assess blood loss.

LIke has been said they cannot refuse to attend you if you stay at home.

 

[allaboard]

Thanks guys, well i have written to the Community Team Manager already - i got a response back - basically reiterating the same thing that they have had to suspend at certain times (ie right now) and they have to consider the safety of ALL women not just those requesting a HB. Basically, they're not shifting. I suggested they get an Indep MW through contractual referral too, but that wasn't responded too and my own Comm MW laughed at the suggestion the unit spend money doing this. It's not that i think there is enough money in the pot, but the point for me is that if more woman refused to comply, they'd allocate more funds to empoly more MWs in order to avoid using the private sector.

I have heard that it's a common tactic to say this at 37 weeks too, and i've been in touch with AIMS about it.

I've been told to expect resistance and if a MW does come out they may assess and then want me to go into hosp due to the position or some other reason that's unnecessary. Basically I'm advised to stay at home and make them come out but not too early so as to give them chance to find a reason to bring me in.

Anyway If anyone can answer re the embolism too that'd be great because it's quite intimidating being told that, when i read other women managed to birth the placenta in the pool fine. Also, if the MW is delayed because they send her from timbuktoo, i'll at least know how to deal with an unplanned home waterbirth (scary).

 

[Tegans Mama]

I've been reading what little info there is on water embolism and it turns out is has never actually happened.

Michel Odent was asked during an interview what the possible downsides of waterbirth were. He didn't know of any, so thought of something off the top of his head - a water embolism. It was actually a theoretical possibility, something that *could* happen, but never has, and he has since retracted this statement.

 

[allaboard]

Wow, thanks so much for that. It's reassuring to know this is where it's come from. The maternity services out to do better than hand out blanket advice given it should be and professes to be based on research findings.

 

[booflebump]

From homebirth.org

Michel Odent apparently teaches that it is important to keep oxytocin production up in the third stage, in order to help push the placenta out and contract the uterus down. Things which help this:

Keep warm - ideally mum and baby wrapped up together under a duvet or blanket
Keep the room calm, quiet, low lights
Personally I worry about staying in a birth pool for the third stage because I believe that we hear about more long and difficult third stages when this happens. It may be that the birth pool relaxes some women too much and it is difficult to get strong enough contractions for the third stage. It can be hard for the midwife to keep an eye on blood loss, particularly if the room is dark. A third stage in water can be hassle for other reasons; it can certainly be difficult to keep both mum and baby at a comfortable temperature and to give the baby its first feed, while ensuring that both water level and water temperature are perfect. There is some discussion about this on the page about waterbirth, but I plan to expand on it soon. I am not aware of any research evidence on the safety of conducting the third stage in water, and while certainly many women do it with no problems, it seems reasonable to question it; it's certainly not something we have evolved to do.

https://www.homebirth.org.uk/thirdstage.htm

More discussion here https://www.homebirth.org.uk/water.htm

From other things I have read, it does seem entirely possible to deliver the placenta in the pool, but there are some factors that could possibly make it inconvenient/more difficult. I think it will really depend on how you feel on the day, if it's something you feel you want to try

xxx

 

[Rebaby]

I'm not actually planning to have my 3rd stage in water but recently had my home visit from the mw's to discuss our homebirth plans, and i asked them if they recommended getting out of the pool to deliver the placenta and they said not necessarily.

I wanted to know their stance on it, in case on the day i felt like staying in there iykwim? They said that in the MLU (which all the community mw's rotate on to) the women are usually encouraged to get out of the pool for the 3rd stage but that is normally because most women opt to have a managed third stage, therefore they need the injection and also cord traction to help the placenta come away.

The mw told me that since i am hoping for a natural 3rd stage it doesn't really matter where i am at the time, but if the water began to get very cloudy and they felt that i was bleeding too much they would ask me to get out, not necessarily to have a managed 3rd stage but so they could more accurately assess the blood loss. The student mw at the appointment said they roughly gauge it by if they can still see your feet- if the water gets too bloody that they can't see my feet clearly then they'd want me out of there to see what was going on. They didn't mention water embolism at all

Obviously i'll have to see how i feel on the day and see what happens at the time, but i can well imagine myself wanting to get out to deliver the placenta anyway as the water will be pretty murky and i may have been in it a long time already.

 

[allaboard]

I understand there is a theoretical risk of a WE, and as long as i stay warm i have a better chance of not having a retained placenta. Interesting stuff and i'll have a look at the links thanks Booflebump

Rebaby i found that really helpful to hear your advice regarding a waterbirth and how that differs, and the part about clouding up and blood loss makes sense, thanks.

 

[shelleney]

I would say that delivering the placenta in the water is not advised - purely because it is awkward/difficult/inconvenient, rather than unsafe. If you want to have your third stage in the pool, thats completely up to you.

And you really must fight for your right to have a homebirth. Staffing levels are not a good enough reason to deny you one!! It is your right to have the birth that you want. Stand your ground!!

 

[allaboard]

Thanks i am fairly certain that i'm going to insist when the time comes.; delivering a baby in a car or ambulance is not an option...i'm not going to entertain that so will be staying well put! it might be they send someone from the other end of the county, who misses the birth, but so be it. I'm scared of getting into difficulties, but certainly not enough to go to hospital, and the odds are on my side if i end up being unattended.

I would have thought that staying put is actually easier, if the placenta follows along reasonably soon ie within 20-30 mins. As long as my water is kept at 36-37 degrees and i'm not fed up of the pool. I might want to get out though, so i'll reassess at the time. It's very frustrating that MWs are spouting procedure that isn't evidence based - i believed that policy and protocol was defined by research findings, so to have a "no, that's not possible" comment, like there is a good chance i'll get an embolism, is frankly criminal. What happened to informed choice and discussion of options?!

 

[tuesday]

My midwife pulled the plug out as I was struggling to deliver the placenta, she covered me with a towel and was tugging on the cord...it really was not budging and took more than a hour to deliver with the midwife pulling. It was more painful than giving birth

 

[allaboard]

I was would be very annoyed about that. Controlled Cord Traction should only be done when the cord start to lengthen to indicate that the placenta is coming away, and there is no way this process would have been so if it took another hour before it came away. Also, by taking out the water, she will have reduced your body temperature and by doing that it increased the risk of the cervix closing shut and you getting a retained placenta. At least next time you know precisely what you won't tolerate happening again! GROWL! Edit: an hour to deliver the placenta isn't actually unreasonable so i don't understand what the rush was :/

 

[moomin_troll]

my mw mentioned to me staff shortages, i just looked at her as if to say no chance will i go hospital lol

anyway my mw got there 5 mins before corey did n the second mw also took an hour to get here tw*ts lol

i was going to deliever placenta in the water but because the pool didnt have enough water in (corey came too fast lol) i had to get out so hed stay warm.

my chest was dried and we were wrapped in towels so we didnt get cold....my frontroom was nice and warm too.

id say make sure u make a nest with lots of towels n dressing gown and go with the flow