What does a homebirth midwife do if there is a piece of retained membrane after birth

[Banana731]

When I had my UC, I ended up with a piece of retained membrane that came down when I had (sorry TMI!) the first BM after my labor. I got some wonderful advice from the mamas on MDC about what to do, and it ended up not being such a big deal But I am a little curious now, as to what might have happened if I had been able to have a MW attended birth, as I had wanted to(not legal for VBACS here). I assume that the membrane tore off when I delivered the placenta. I squatted over a bowl, and while it wasn't a long distance to go, I figured that it must have occurred because I didn't support it as it came out. A midwife would have done so, correct, so my chances of having retained membranes would have been less likely, right? But if I had ended up with the retained membrane for some reason, the MW would have done a better job than my dh at inspecting my placenta and membranes(lol) and would have seen a piece missing, right? What would have been done in that case?

[terrabella]

I don't know. I just always assumed my midwife would tell us what to do next. How lame of me. Now I feel obligated to go do some reading...

ETA: Arggh! first page I land on p*sses me off:

The third stage can be speeded up with an injection in your thigh, given just as your baby is being born. This is known as a managed third stage and usually takes about 5 to 10 minutes (Dombrowski et al 1995; Magann et al 2005). Managing the third stage reduces the risk of you experiencing heavy bleeding (NCCWCH 2007: 178).

WTH? An injection. Why can't they say pitocin? A woman is just supposed to be ok with "an injection"? Wouldn't she want to know of what? "It's the magical third stage injection which shall not be named."



Ok, they made it up to me with this:

Sometimes a full bladder will prevent the placenta from being delivered, so your midwife may insert a catheter to drain your bladder

(they didn't say OB or midwife, just midwife. )

[terrabella]

Gosh, I'm creeped out by what has to happen after you get to the hospital.

I retained a placenta once. My midwife had me take all the usual herbs, and we nursed, squatted and etc. I assume, that this is really all that you can do on your own. And if in the end it all fails, you just need to head to hospital.

I just read this too:

After her second child was born all of the placenta was not delivered, two weeks later she hemorrhaged. (she was ok!!!)

Wow. That's longer than I would have expected! Thank goodness she was ok.

[Banana731]

Thanks for the research!

Well, placenta-wise, everything was fine! It was whole and came down on it's own. No hemorrhaging or anything like that. It was definitely just a small piece of the membrane. When it came out, it looked like chicken skin(that's what it looked like to me, anyway!) My husband and I inspected the placenta, but we didn't inspect the membranes in the proper way. My understanding now, is that you are supposed to be able to see that there is just a tear in them where the baby came through, not any pieces missing. Because we didn't see it, I had no idea until I was on the commode and I felt and saw and then it was, "um, what the... " I was totally okay, my uterus was contracting, getting firmer, I had (what seemed to be in my experience) normal lochia. When I did gently remove it(it was caught in my os) I did get some stronger afterpains for a bit, that I assumed were from my cervix closing completely.

I figured someone might have a similar experience, or one of the birth pros might have encountered it, maybe?

[terrabella]

Originally Posted by Banana731

Thanks for the research!

Well, placenta-wise, everything was fine! It was whole and came down on it's own. No hemorrhaging or anything like that. It was definitely just a small piece of the membrane. When it came out, it looked like chicken skin(that's what it looked like to me, anyway!) My husband and I inspected the placenta, but we didn't inspect the membranes in the proper way. My understanding now, is that you are supposed to be able to see that there is just a tear in them where the baby came through, not any pieces missing. Because we didn't see it, I had no idea until I was on the commode and I felt and saw and then it was, "um, what the... " I was totally okay, my uterus was contracting, getting firmer, I had (what seemed to be in my experience) normal lochia. When I did gently remove it(it was caught in my os) I did get some stronger afterpains for a bit, that I assumed were from my cervix closing completely.

I figured someone might have a similar experience, or one of the birth pros might have encountered it, maybe?

Well, I only glanced at a few pages, you my want to look into it further

Yeah, after checking for a whole placenta you then gently pull the membrane together, to see if it all matches up. Rinsing it off, really helps with making it smoother/clearer to see, if you're unsure.

[mntnmom]

WOW! They're supposed to give you drugs for that!! The OB with my first babe just reached in a pulled it out!! And it wasn't even retained! That's the reason I'm reading up on all things I need to know OUT of hospital. thanks for the great questions and info!
[QUOTE/]
Gently?! Thank heavens they knock you out or that part. Yikes. I think my uterus just clamped down in protest.

Oh yay, here is some distressing news for us:[/QUOTE]

[terrabella]

Originally Posted by mntnmom

WOW! They're supposed to give you drugs for that!! The OB with my first babe just reached in a pulled it out!! And it wasn't even retained! That's the reason I'm reading up on all things I need to know OUT of hospital. thanks for the great questions and info!
[QUOTE/]
Gently?! Thank heavens they knock you out or that part. Yikes. I think my uterus just clamped down in protest.

Oh yay, here is some distressing news for us:

[/QUOTE]

And you didn't hit him?

[mntnmom]

No.... didn't realize how bad it was until years later. i have fantasized about kicking him in the face though!

[terrabella]

Originally Posted by mntnmom

No.... didn't realize how bad it was until years later. i have fantasized about kicking him in the face though!

Did this happen in Germany? I always think of Europe as being so awesome in regards to birth. Was there an urgent need because you were bleeding? Sorry for being nosy.

[rachel65655]

If you choose a managed third stage, you'll be given an injection of an oxytoxic drug to make your uterus contract and your midwife will use controlled cord traction to gently pull the uterus out.

Sorry but I found this funny...I thought they were trying to pull the placenta out...not the uterus.

[terrabella]

♥

[MsBlack]

I think even highly experienced mws will miss a piece of membrane now and then, on inspection of placenta/membranes. I mean, it's pretty obvious when a lot of membrane is missing--but believe me it's not that easy to look it over and reconstruct the whole thing in your imagination.

But a bit of retained membranes is not a big deal in any event, most often.

[Mamabeakley]

I don't actually think retained membrane has much to do with whether the placenta is supported on its way out. I could be wrong, but .

I also believe that a piece of retained membrane isn't necessarily a problem unless it seems to be irritating the uterus, perhaps keeping it from clamping down properly.

Removal can certainly be done without anaesthetic - I had a bit removed at home by a CNM w/out medication, and I saw the same thing done at a relative's birth. It's not fun, for sure, but not unbearable. I did have my mom hold the baby because I didn't want to drop him while coping with the experience.

[broodymama]

When DD2's amniotic sac broke (when she was crowning) it pretty much shredded, I had quite a few retained membranes. My midwife gave me some angelica tincture to help them along. Most of them passed within about 30 minutes, then the final few when I was showering an hour or two later. With how torn up the membranes were (pieces floating in the birth tub), it would have been near imposible to see if there were any missing.

[katelove]

It can be hard to tell if there is any membranes missing and you can't definitively say that there is any retained until you get the piece(s) out. I would write "ragged mambranes" in the notes and then observe for any increased bleeding, poor uterine tone or signs of infection (later on). I assume a homebirth midwife would do something similar.

I'm sure heaps of people have little bits of membrane which are passed in clots without anyone ever realising.

ETA- you can reduce the risk of bits of membrane tearing off by twisting the placenta as it is born but that might be a bit tricky to do on yourself.

[Banana731]

Interesting. Sac broke as dd came flying out! So it certainly could have been then, I suppose.

I'm thinking the piece was about 4x2 inches, roughly, so it wasn't tiny. But from what I'm reading, what happened would have been the same, most likely? I was wondering if in a hb, a mw would try to extract it or if she would have said "look out for x,y,z because you have some membrane missing." From what I've seen in the hospital, I don't think a Dr would have even noticed the missing membrane, but if they did I could totally see them reaching in there and trying to get it out...

[flapjack]

I've noticed that my midwife's "checking for tears" has sometimes gone to my cervix and other times not, and I've assumed that that was suspecting a piece of membrane still up there. And yes, I know more than one person who has still had some placenta retained at a week.

[MsBlack]

I also had a fairly large piece of membrane retained after one of my UCs--4" x 2" sounds about right. In my case, I got a bit fevery and achey in the uterus on the 2nd day--not seriously so, but I decided I might have retained stuff so I drank about 2-3 cups of ginger tea from about 40hr pp through the 3rd day. It helped reduce symptoms fairly fast, and then early on day 4 the piece came out while I showered. All was immediately well after that.

[paquerette]

I had a bit retained. I was given angelica, asked to cough, cough some more, cough some more... it was stubborn but it finally did come out.

[mntnmom]

Originally Posted by terrabella

Did this happen in Germany? I always think of Europe as being so awesome in regards to birth. Was there an urgent need because you were bleeding? Sorry for being nosy.

nooo, it was an "Indian" hospital in Oklahoma.(run "for" Indians, not by them)