third stage

[kosh]

i'm very confused about this, what are all the options?
could someone explain the pros and cons of a natural and a managed third stage?

thanks!

 

[hot tea]

I had this question as well. No one seemed to be able to answer me straight, not with information that really backed what they said, anyways. My stance is zero interventions, all natural and unmedicated... But there is really very little reason not to get the leg jab.

The leg jab lowers the chance of hemmorraging drastically. Imo it is a small intervention that does have benefits, unlike many others.

Other studies have shown that the leg jab may lower your oxytocin levels 12 hours after birth. But there is little real stats that back this up.

As a person who wants an unmedicated birth, I wll begin with no jab. As I trust my midwives to be very attentive, they will give me the jab if they feel I am at a high risk of hemorraging and will do so only then. Once you start bleeding like that, it becomes life threatening pretty quickly. But as long as you have trustworthy care providers, and you know the risks, you should be fine.

I am also having a homebirth.

 

[Kess]

The injection raises the risk of retained placenta, and I'm not sure you can do delayed cord clamping with a managed 3rd stage? It can also have side effects such as nausea and vomitting, which isn't a good way to spend the first hour or so of baby's life IMO.

 

[hot tea]

You can do a delayed cord clamping the shot, that is no problem.

 

[kosh]

The injection raises the risk of retained placenta, and I'm not sure you can do delayed cord clamping with a managed 3rd stage? It can also have side effects such as nausea and vomitting, which isn't a good way to spend the first hour or so of baby's life IMO.

excuse my ignorance - what are the benefits of delayed cord clamping?

 

[lynnikins]

benefits are that baby gets all their blood up to 30% of the babys blood volume is in the cord and placenta at birth so you are allowing that to trasfer back to the baby improving overall outcomes for your childs health.

hot tea, there is anecdotal evidence to show that unless the shot is only to prevent excess blood loss after the birth of the placenta that it isnt nessacarily the best idea to delay cord clamping then have the shot as it increases the risk of a retained placenta if it hasnt already been delivered, esp since most MW's would administer the shot to " hurry on" the arrival of the placenta causing the uterus to contract over it and retain it when its quite alright for the placenta to take over an hour to arrive naturally as it relys on the mothers own oxytoxcin production speed.

 

[kosh]

thanks lynnikins
and how delayed is a delayed cord clamping?

 

[Kess]

thanks lynnikins
and how delayed is a delayed cord clamping?

My birth story is in my siggy, I had both delayed cord clamping and a natural third stage. I can't remember exactly how long I waited (I think it's writted in my birth story if you want to check), but tbh it felt like a couple of minutes (I know it was longer than that, but when you've just given birth you're so focussed on gazing at the baby it feels like seconds). My baby was/is very healthy, no jaundice at all, Apgar scores were 9 and 10. The placenta arrived easily with next to no effort on my part, it was fab, and I only lost 300ml of blood in total.

 

[lynnikins]

mine was about 10 min till it stopped pulstating then we cut it then another 25 min or so till the placenta arrived

 

[labydird]

I think you need to see how your labour goes. With most, if they lose a lot of blood suring labour, your iron will be low and you may not be allowed a natural 3rd stage.

3rd stage can take anywhere between 10 minutes and an hour. Putting baby to breast immediately and letting him suckle releases the same chemicals as the symtometrine jab- to contract and seperate the placenta which is why baby to breast is so important as soon as he is born!

With my 2nd child, the VBAC went well, however I did ask for a natural 3rd stage, they waisted about 30 minutes however there was no show of the placenta and I did not have any sensation to push either. It was an hour before a doctor came in and literally had to stick her hand up and pull it out because it had been too long and I had bled quite a bit during labour.!!

3rd time, baby was born at home without anyone present paart from my husband, the midwives arrived 45 minutes later to cut cord and deliver placenta as it still had not made an appearance yet (again I had no sensationt o push or anything!)

Anyway best to see how things go and be flexible in terms of what you would like when the time comes!

 

[madasa]

There is a higher risk of retained placenta with the jab. You can start out with "no jab" and then reconsider if they are concerned about blood loss. I can't see how this would be any "worse" than just having the jab, but maybe i am missing somehting?

It does reduce the risk of "haemorrhage", that is true, but it's not the ONLY way of preventing haemorrhage. (BTW, in clinical terms it is anything more than 500mls.)

Michel O'Dent has a LOT to say about the third stage. Don't wake the mother!

Very good piece on the 3rd stage (regardless of whether you birth at home or in hospy): https://www.homebirth.org.uk/thirdstage.htm

https://www.waysofthewisewoman.com/dr-michel-odent-notes-obgyn-studies.html

https://www.bellybelly.com.au/birth/natural-approach-to-labour

Excerpt ^ ^ :

Haste becomes necessary, because the oxytocic injection will, within a few minutes, cause very strong uterine contractions that can trap an undelivered placenta, making an operation and ‘manual removal’ necessary. Furthermore, if the cord is not clamped before the oxytocic effect commences, the baby is at risk of having too much blood suddenly pumped from the placenta by the over-zealous contractions.

https://midwiferytoday.com/articles/firsthour.asp

https://www.sarahbuckley.com/leaving-well-alone-a-natural-approach-to-the-third-stage-of-labour

There are probably more....

 

[madasa]

Yep - here is another one!

The Bristol Third Stage Trial

 

[mrscupcake]

I've done my midwifery training and it always shocks me how much you ladies know!! Which is good. Anyway...only thing I can add to this is if you are thinking about a water birth then you can still have the active 3rd stage but you have to get out of the water pretty much straight after the birth so the midwife can examine and ensure safe delivery of the placenta & membranes. If you have a physiological 3rd stage then you can stay in the pool alot longer. Midwives where I trained would leave it an hour before advising you to take the injection. That's in the UK though.

 

[PoodleMommy]

benefits are that baby gets all their blood up to 30% of the babys blood volume is in the cord and placenta at birth so you are allowing that to trasfer back to the baby improving overall outcomes for your childs health.

Also, if the mother is Rh- and gives birth to an Rh+ baby, it minimizes the need for her to get the Rhogam shot. (This is a rare situation, but it happens to apply to me and this is a big reason I am doing delayed cord clamping, so I thought I'd mention it!)

With delayed cord clamping, I'm guessing banking cord blood is out of the question since presumably there wouldn't be much blood left in it?

 

[madasa]

True, but if you bank the blood there's a small chance it will be use. Physiological cord clamping means there's a 100% chance it will be used!