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 (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!!! 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!

 

[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

 

[kiwimama]

Thanks for that hun! 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!

 

[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

 

[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.

 

[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.

 

[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.

 

[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.

 

[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

 

[flubdub]

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.

 

[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.

 

[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!

 

[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.

 

[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

 

[Mervs Mum]

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!

 

[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.

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!

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.

 

[Mervs Mum]

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!

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.

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

 

[Blob]

I had the injection last time and still had to push it out 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

 

[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.

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!

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.

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

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?

 

[JenStar1976]

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