Physiogical v managed third stage?

SarahSausage

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Hi I was hoping for a bit of input into the pros and cons for each of these. I an hoping for a natural third stage but are there disadvantages to this? Is it less likely to come away completely compared to if it is managed and I receive the injection. Also I want my baby's cord to stop pulsing before being cut and clamped so that will affect the timing of the injection also. Any advice is appreciated. Thanks.
 
i have had both, i wanted to go natural both times but due to intervention in the birth of ds1 i didnt have the chance to say no before they stuck me with the needle. i remember there being a bit of rush and tugging on the cord with ds1 to make sure it came away before the uterus contracted caus it can trap the placenta and require surgery if it doesnt come away fast enough.

with ds2 i was firm with them and told them no injection and i got to cuddle and feed ds2 whilst the cord was still pulstating and they couldnt take him away to look at him he got checked over while feeding it was nice and DH got to clamp and cut the cord when it had stopped pulstating and after about 35 min or so i got a couple of contractions and out it popped all fine all in one peice and HUGE lol they needed a bigger bowl for it.
it was nice to have them leave us alone a bit to bond with ds2 caus ds1 i saw for all of 20 seconds before he was whisked off and cleaned and dressed and given to OH and my mum to cuddle and it was over 2 hours before i got him back for a quick cuddle before my shower
 
There is a in increased risk of retained placenta with the managed (injection) third stage. A physiological third stage MAY be slightly longer but not always. I've seen them vary from 10 mins to an hour plus but always a complete placenta after. Managing the third stage can help reduce PP bleeding but the risk is the uterus clamps down so fast on the placenta it can be retained fully or partially. Anecdotally women bleed more when having a natural third stage immediately after they give birth volume wise (I'm not talking PPH here) and have less ongoing bleeding (lochia) but with a managed one bleed less initially but have heavier lochia. This is purely anecdotally though.

I've have both and I'd always have physiological. I dint see the pount if adding synthetic hormone into the system unecessarily when there are enough flying round already! There are no time scales on having the injection so you can take a wait and see approach and if bleeding looks little on the brisque side have the injection.
 
Wish I'd read this before the weekend, might've thought harder before changing my plan at the last minute! :dohh:
 
I came on to ask this exact same question :thumbup: thanks ladies you have just confirmed what I had already decided. I just won't mention it to DH until I'm in labour and he's too afraid to argue otherwise :)
 
Thank you for this! I've been considering the options. I had a managed 3rd stage with Alyssa, and am aiming to have a physiological one this time round.

PeanutBean, congratulations on Indigo's arrival! Reading your birth story now - what a beautiful name! :cloud9:

x
 
Id see how your birth goes and decide at the time. The pros and cons of both are on a par so i think that you need to take other things into consideration.
 
I don't subscribe to the 'see how it goes' school of thought. Make a decision before on how you want it to be but know that if things change and it's appropriate you cam always rethink on the day :D
 
I don't subscribe to the 'see how it goes' school of thought.

I did until I got everything I didnt want last time...going with the flow seems to lead to accepting what you're told to do.
 
Ive said this elsewhere before but you dont 'try' to run the marathon - you commit to doing it, prepare and then go for it. If something crops up en route you may adjust your plans but its important to have that goal or as you say may just float along with the tide and go with who ever pulls or pushes you hardest. Commitment to your birth is key in achieving it. no one ever made their dreams come true by going with the flow and just hoping for the best!
 
Id see how your birth goes and decide at the time. The pros and cons of both are on a par so i think that you need to take other things into consideration.

Like what?

In my case i wanted a natural 3rd stage as i wanted delayed cord clamping. That couldent happen as she needed resusitating so the cord needed to be cut asap to take her to the resusitare. The reason i wanted the natural 3rd stage wasent there anymore so i then chose to have a manged 3rd stage.

I don't subscribe to the 'see how it goes' school of thought. Make a decision before on how you want it to be but know that if things change and it's appropriate you cam always rethink on the day :D

I dont see the defferance in rethinking and decideing at the time lol, of course you can have a preferance but for some people if you are adamant your doing xyz but if things have to chance it can leave you with regrets and a sence of guilt.
 
I am and have been committed to a natural third stage but wanted to know if I have overlooked any reason not to choose this. I didn't even get asked with my first-a theme that ran through the whole induced intervention based, prolonged labour and delivery. This time I am committed to a natural hypno waterbirth, if all goes to plan, and that includes the third stage too hopefully. However as they say, the best laid plans of man and mouse...
 
This thread has been really helpful for me thank you :thumbup:
 
Id see how your birth goes and decide at the time. The pros and cons of both are on a par so i think that you need to take other things into consideration.

Like what?

In my case i wanted a natural 3rd stage as i wanted delayed cord clamping. That couldent happen as she needed resusitating so the cord needed to be cut asap to take her to the resusitare. The reason i wanted the natural 3rd stage wasent there anymore so i then chose to have a manged 3rd stage.

Hmmmm.... This is interesting to me, because something similar happend with my first baby. What I have never understood is: his cord and placenta were not compromised, so he should still have been receiving oxygen etc. from there. He came out "needing resus" - surely that means he needs what the cord and placenta have to offer even more than a baby who comes out NOT needing resus? I could not understand why they cut the cord in order to resus him, it seemed so..... illogical. :wacko: Why not leave it intact and resus him RIGHT NEXT to me? That way he gets everything he should have from the placenta AND he gets any additional help from the staff that he might need. I still don'tget it....

There is an enormous difference between "going with the flow" (ie, not making a plan at all) and making a plan but being flexible about it. I know, because I have done both. Without fail, where I have planned in advance, the outcome has been better than when I have thought "oh I will just see how it goes".

The first time, I had NO plan. I also had zero control over how ANYTHING was managed. Everything was directed by the hospital staff and, frankly, it was a bloody nightmare from start to finish.

My second baby I knew what my options were, I knew what my preferences were, and yes we did have to change plans a little on the day, but overall the experience was WONDERFUL. The only part I would change for "next time", would be a firmer "birth plan" for the part I didn't really bother with this time....

(Now, see if you can guess which part I neglected in my plan and decided to just "go with the flow", and which part was the bit that went Pete Tong and required us to change what we did on the day... ;) )

Most women I know spend MONTHS planning a wedding, if not years! Anything could happen, it could rain, they might become ill, guests might get drunk and get into a fight, the cake might get knocked over and spoiled, she might get a giant ZIT on her chin on the morning of the wedding.... SO much she can't control, why bother planning anything, right?

There is absolutely an element of surrender in birth. But that doesn't mean give up any hopes or preferences you may have. You stack the odds in your favour, you get your ducks in a row.... So that on the day you have the freedom and confidence to let go and surrender.... IF something crops up that requires a change of plan, you deal with that and move forward without beating yourself up over it, this is entirely different than NOT giving yourself that "safe space" in which to surrender to the birth process in the first place. :D
 
I asked my midwife about forgoing injection and having natural 3rd stage and she seemed pretty shocked and asked why as 90% of women have it now and they encourage you to have it so you don't bleed excessively. She did say it was my decision but you might get the midwife huffing and checking their watch ass they won't want to wait around! My mum thinks the 90% of people are encouraged to have the injection to save time on their part as she never heard of such an injection when having us and to go with what I want but now I'm not so sure, what if the mw makes me feel uncomfortable about it all due to having to wait around? I don't like to think I'm going against the grain completely...now I'm afraid to ask about delayed cord clamping as that will take even more time... no one discussed these thin.vs with me as options, they are ideas I have come across from reading on here...why were they not discussed? Although these mw seems lovely I'm getting the feeling already its going to be very medically laid care...
 
It's not discussed because as you said it (sometimes) saves them time (and therefore staff) to give the injection and pull it out. There should be no huffing and puffing and if there is I'd remind them its not about their convenience contrary to what they my believe!
 
My midwives encouraged me to try to plan not to have the injection if everything was going well with the birth and I could always change my mind (or they could advise me to if for some reason they thought it was necessary). They took the stance that if you are having a natural home birth, why have an injection once the baby is out.
 
Our current plan is to have the injection on hand in case we need it, but to have a physiological third stage unless I'm bleeding too heavily or something. That's the thing, you can't change your mind after the injection, but you can change your mind the other way.

I'm really scared of a retained placenta - they have to do a D&C don't they to get it out? That'd just remind me too much of my miscarriage, and the D&C knocked me about so much then it was awful. I'll be putting Bubs to the breast pretty much straight away and hoping that helps get the placenta out. Any other tips to go natural?
 
Delayed cord clamping will help prevent a retained placenta, as well as so many other benefits. I would highly suggest it!
 

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