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Originally Posted by cfiddlinmama
Hi everyone! I got to go to another birth last night! It was absolutely beautiful. Mom labored so peacefully. I feel like it's such an honor to get to witness these births!
Question for those who are apprenticing: How much do your preceptors mange the third stage? Mine definitely manages it. I don't think excessively so, but maybe a little. She does fundal massage every 5 min. for the first 20 min. and then every 10 min. for the next 30 min. and then every hour or so until we leave. The three births that I have been to, the moms all got misoprostol (Cytotec) and one got pit and methergine (she was definitely hemorrhaging.) It seems like she's a little quick to jump to the misoprostol. The mom last night was clamping down nicely and had no where near as much bleeding as the others did. After 20 min. though, they gave her the misoprostol because she was passing a lot of clots.
The thing is the misoprostol gives the moms such horrible shakes. The fundal massage is so painful (even though she's as gentle as she can be.) I'm wondering if it's necessary for the third stage to be so uncomfortable.
She seems to approach it from a better safe than sorry mentality. I was curious what your preceptors do. (Not criticizing here, just trying to learn...) It's really humbling how much I have to learn.
I hope you all have a wonderful day!
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Congrats on the birth!!! It is soooo special to witness birth.
At the 5 homebirths I've been a doula at (I'm not apprenticing yet), this is how third stage has been managed:
First birth: About 15 minutes after baby, mom was bleeding more than usual and the placenta had not come yet (and baby had been nursing for at least 10 minutes--she came out starving and rooting like crazy!), so the midwife gave the mom an IM injection of pitocin. The placenta came about 5 minutes later, and the bleeding stayed within the normal range of blood loss.
Second birth: the amount of bleeding was completely normal and the placenta came out about 15 minutes after baby was born. No fundal massage or drugs were used, mom nursed soon after birth.
Third birth: mom had hemmorhaged with her previous baby, so the mom and midwife decided prenatally on a routine IM pitocin injection immediately after baby was born as a precaution. The placenta came 11 minutes after birth and there was no abnormal bleeding.
Fourth birth: this was the mom's 6th baby (fourth homebirth) and she had a history of hemmorhage. She took red raspberry leaf tea, nettle, and alfalfa religiously during pregnancy. Mom preferred a natural approach to hemmorhage and midwife and mom agreed prenatally to use an herbal tincture "hemhalt" routinely every five minutes starting at birth and to use a "watch and wait" approach to pitocin--midwife would have the syringe drawn up, but would not use it unless abnormal bleeding occurred. The placenta came 17 minutes after birth and mom recieved a total of 5 doses of hemhalt (2 after the placenta came); there was no abnormal bleeding. In fact, she bled the least out of all the births I have yet seen, including hospital ones where there is a routine IV bag of pitocin after birth.
Fifth birth: the amount of bleeding was completely normal and the placenta came 16 minutes after baby was born. No fundal massage or drugs were used. (FYI, this birth was a different midwife than the first four births)
I have talked to my future preceptor (and the midwife for the first four births) before about 3rd stage management, and this is her usual procedure, when there is no pre-existing risk of excessive bleeding:
As long as bleeding is normal, she does nothing but check the uterus every 5 minutes or so (not fundal massage, just gently feeling the uterus; none of the moms that I have witnessed have expressed pain when she does this) until the placenta comes. After the placenta comes, she periodically feels the uterus to make sure it is hard but doesn't do fundal massage unless the uterus is soft and not contracting down or she suspects a retained piece of placenta.
As long as the placenta comes within 20-30 minutes and bleeding is fine, she is comfortable that. Usually at the 30 minute mark, even if everything is fine, she will recommend an herbal tincture and most of the time the placenta comes immediately. She will use pitocin if there is excessive bleeding after birth (or after the placenta) or if the placenta doesn't come after she administers herbs. She has waited up to an hour for a placenta because everything was completely normal and the mom preferred to let her body release the placenta on its own, as long as she wasn't bleeding excessively or anything.
So, those have been my experiences--hope they help!