EVER pull on placenta/cord??

[CageFreeFamily]

As I'm getting ready to have my third baby (11.09) I'm reflecting on my first two. The first was a homebirth to hospital transfer The second was a truly beautiful, healing homebirth.
There's just one thing that has been bothering me for the last couple of years, and now more than ever.

In what seemed like a very short time after DD was born (before the cord stopped pulsing) my midwife told me that my cervix was closing and she needed to cut the cord and get the placenta out.
I switched from a blissed out state to a rapid attempt at understanding what she was saying. It all happened so fast, and it was so painful to have the placenta pulled out that I remember screaming out in pain. Such a different sound and feeling from the labor, pushing and even crowning it scared my DS and DH.

Thinking back now I'm trying to understand why this happened. I had an old-school, incredible midwife. VERY crunchy and not in the slightest bit interventionist. She had only been there for about 3 hours because DD came so quickly, so she wasn't making decisions from fatigue... it wasn't late either. I was her second to last birth, as she was retiring a month later after a LONG career.

I can't understand why she would have even been checking my cervix so soon after DD was delivered (and I don't recall her doing so, actually)... why she didn't try something to expel the placenta first and under what circumstances a placenta should be pulled out? Even if my cervix was closing up, couldn't it still have passed a soft, foldy placenta?? It's not like it was going to clamp shut in a matter of minutes is it?

Anyone have any info about this sort of thing? From everything I understand it isn't even uncommon for it to take hours to deliver the placenta without complication.

[jess152]

I"d post in the Birth Professionals section for more input.

I"ve read different things though. Some places say 'gentle traction on cord' is needed while others say not at all, that the uterus will do the proper work it needs to expel on its own. Who's right? There are so many birth stories where the placenta comes later, not just a few minutes later, either. And I would think (layman's opinion here!) that by pulling on the cord, you could tear or separate part of the placenta and be left with some pieces inside. That can be a dangerous thing for the body to resolve on its own. I can't imagine why your m/w was in such a hurry...? Post on the other board and see what kind of response you get. It would be interesting to read.

[CageFreeFamily]

I would love to, but the forum guidelines say that it is for birth professionals only, "no ask-the-expert questions"

I wonder too, if this is the reason why she told me that I couldn't go downstairs (my bedroom was upstairs) for several days and then that I could only do the stairs once a day for TWO WEEKS! The after-pains were excruciating too.

[womenswisdom]

Originally Posted by CageFreeFamily

I wonder too, if this is the reason why she told me that I couldn't go downstairs (my bedroom was upstairs) for several days and then that I could only do the stairs once a day for TWO WEEKS! The after-pains were excruciating too.

No input on the cord issue, but my mw told me the same due to a 2nd degree tear that was stitched.

[kriket]

I had always heard you should pull. I was very surprised when my MW tried to pull. I asked he not to and she said "it's ready, do you want to try and push it out?" I was like, ok, pushed a little (less then a bowel movement) and felt it slip out. It was less then 10 mins after birth.

I know that doesn't answer your question, but since you can't ask the pros I figured I would share my experence.

[Harmony96]

Originally Posted by kriket

I had always heard you should pull. I was very surprised when my MW tried to pull. I asked he not to and she said "it's ready, do you want to try and push it out?" I was like, ok, pushed a little (less then a bowel movement) and felt it slip out. It was less then 10 mins after birth.

I know that doesn't answer your question, but since you can't ask the pros I figured I would share my experence.

I had a similar push-pull combo w/ my homebirth earlier today. My MW pulled out all the extra cord and then did VERY gentle traction to see what the placenta was doing, and asked me to push it out, and out it came.

[MsBlack]

Something does not sound right about this. I've done, or had clients do, some cord traction to help placenta come--but no one has ever said it hurts. Traction should only be used (if at all--I don't consider it a necessity but more a matter of convenience sometimes) when it is certain that the placenta has separated fully from the wall of the uterus. Traction should work to bring the placenta within a few seconds of firm but gentle pull--if it doesn't, you have to stop doing it so as not to pull out the uterus with the placenta, and/or cause a major bleed. It could hurt a lot if the placenta was not fully separated, it could also hurt if the cervix really is closing up. In either case, you are not just pulling on the placenta, you are pulling on the uterus as well-- and that is dangerous and most definitely could hurt!

If the cervix is closing on the placenta, this is not all that concerning to me. The placenta will come--it will simply take more time and after-contrax to get it to come. Our bodies are capable of doing this! AS long as the uterus is firm and low, and there is no bleeding, mom feels fine, then it's ok to wait longer--even up to several hours. But I've seen a few similar scenarios where we stopped 'trying' and mom just relaxed in an upright position--walk to the toilet and sit on it for a time, move around in bed a bit and settle in a sitting -up or kneeling upright position--the key is to relax I think--attend to your baby, have a bite to eat or some tea, forget the placenta for a time. It then falls out usually--or the mom then gets a more definite set of contrax and urge to push that brings placenta easily.

Did you get a record of your birth from the mw? Get a look at her notes--ask her for a copy if she didn't already give you one--and see if she wrote down time of placenta delivery. You'd also want to see if there are any notes about blood loss, the state of your uterus, etc. These things may give you clues as to her rationale. Perhaps she would even sit down with you and discuss the birth/3rd stage with you, explaining her actions. There may have been a reason for her actions that you are not aware of (or else that you did not convey in your original post).

By the way, afterpains that come with 2nd baby and beyond are generally MUCH more painful that afterpains with a first baby. Some moms say they get worse with each baby (regardless of birth details) and this has been my experience as a mom of 6. I mean, the intensity of the afterpains you had *could* be related to cord traction--definitely could. But not necessarily.

[MsBlack]

Just a further thought--

perhaps your mw did NOT do an internal exam to determine that your cervix was closing--could be instead that she simply felt your lower abdomen (externally), and from the firmness and low position of the fundus she made an educated guess that your cervix was closing. And she could well have been right, tho that doesn't mean that vigorous cord traction was the 'right answer'.

[nashvillemidwife]

She also could have just been stating a concern. She's right, the cervix will close, you don't need an exam to know that is a certainty. If a placenta has detached I want it out. Period. If it's detached that means you're bleeding, and if the placenta is still there that means your uterus is just filling with blood behind it. If you wait until the cervix starts to close it's just that much harder to get it out, you're going to have that much more bleeding, and that much more risk for a hemorrhage.

[mwherbs]

hum I don't pay much attention to the cervix closing but if I see signs of separation then will try to get the placenta delivered-including using controlled traction . how much blood? how long after birth ? is mom having contractions? is she feeling discomfort? is the fundus rising? so if the cervix is closed and the fundus is rising you probably have a partial separation it could be painful to get the placenta out on the other hand this type of situation can quickly become lifethreatening
most placentas on their own come within 15 minutes of birth but I have waited hours for some placentas if there are no signs or symptoms of separation on the other hand signs and symptoms are clear indication to get a placenta delivered.

[Kidzaplenty]

[pamamidwife]

I've done cord traction with a placenta that has detached. Sometimes it feels weird and a bit sore as it comes through the cervix, but never excruciating pain!

I've waited for as long as three hours with a placenta that has detached to come out. As long as bleeding stays minimal, I'm fine waiting, but most of the time mom wants the placenta out and she'll do things (including traction) to help birth the placenta. Sometimes I'll follow the cord up with a finger to see if the placenta is just hanging out in the vagina/cervix.

[prothyraia]

At my first birth (hospital, with a CNM) I had "controlled cord traction" after about 20 minutes. It was the most WRONG feeling I have ever had- I swear, if I had been a cartoon character my eyes would have done that thing where they jump out of your head. And I had an epidural in place at the time! No way was that placenta completely detached. Mild hemorrhage, but afterpains weren't too terrible.

Second child, born at home, waiting just over an hour for the placenta to come out on its own, and the afterpains were so bad they made me wish I was in labor again.

So, that's my two experiences!

[dziwozony]

i am not a midwife, just a birthing mum who has read up on this after wanting to have a more laid back 3rd stage with my second babe.

there are two approaches to the 3rd stage: physiological & actively managed. the physiological approach means that there is no rush for the placenta to come out in a healthy birthing mum as long as there are no signs of hemorage, etc. the active management approach believes the cord should be clamped & cut & that the placenta needs to be encouraged to come out asap. these two approaches can be held by both OBs & midwives, so you need to clarify with yours what their philosophy is.

i had an actively managed 3rd stage with a homebirth midwife with my first son. from what i remember, she cut the cord after she declared it had stopped pulsing...it was much sooner than i would have liked (20 min), but i was so blissed out i didn't pay much attention. she then gently tugged on the cord. the placenta came out with some membranes missing, so she gave me a shot of something-or-other to expel everything...which didn't even work as more membranes came out a couple of weeks later. i felt frustrated that she was in a rush & i wonder if that's how the bits of placenta seperated in the uterus to begin with.

for my second birth i wanted the 3rd stage to happen more naturally...be careful what you ask for! we waited 3 long hours!!! my midwife thought that maybe the placenta had detached about 1/2 hour after the birth, but was unsure. so we waited & waited...i was only having *really* mild sporadic contractions. finally, during a weak one, she gave a gentle tug & out it came. so it probably did detach way back & just didn't come out. i kind of wish we tried a gentle tug earlier because that would have been that.

so in one case i wish she left it alone & in the other more intervention might have helped! (just because i was really tired & couldn't fully relax until the placenta was out & it was making my bliss wear off from starting to feel impatient).

i bled very little both times & had no complications.

[mwherbs]

sometimes membranes just shred- we try to twist as the placenta comes out so that the membranes rope together and are stronger- often but not always if a placenta comes out maternal side first the membranes trail and are more likely to shred off-