Reasons for Retained Placenta?

[ShwarmaQueen]

I'm still processing DS's birth (HBAC with transfer after for retained placenta/PPH) and wonder if there was something I could have done to prevent the retained placenta. I drank RRT religiously throughout my entire pregnancy, nettle and alfalfa in the third trimester, let the cord go limp, had herbs immediately following birth, and let baby latch right after birth.

Could it been because of a long labor? I had prodromal labor for approx 36 hours, then 'active' labor for 14 ish.

Or could it have been because DS was a little on the chunky side? 9.2oz, 21 1/2 inch long?

Any guesses, educated or otherwise?

TIA!

[Xavismom]

I would be kind of curious to know this too. I had retained placenta and membrane, but did not find out until about a week PP.

I had prodromal labor too (for over a week though, ugh) and also drank RRL.

Hope someone knows? I've been thinking about making a post like this myself.

[jengacnm]

Yes and yes. Long labor and big baby can lead to uterine atony-in simpler language, you had your baby and your uterus said, "Ok. I'm done. No more contractions for me; I've worked hard enough, thanks."

With a prior c section there's always a chance of a percreta/increta/accreta, but it doesn't sound like that for you.

Did you have a UBAC, or did you have a midwife? Did she carry pitocin? I've become less hesitant to use pitocin for retained placentas after we've tried everything else.

Jennifer
Home birth CNM

[hillymum]

I have had two retained placenta's with PPH. I was informed it was due to having fibroids. Durring my third pregnancy I had no fibroids (I had a few extra scans to keep an eye on it), prodermal labour for over 3 weeks and delivered my placenta with no problems following a 90 minute long labour. Pitocine didn't help me at all with the retained placenta.

[ShwarmaQueen]

Originally Posted by jengacnm

Did you have a UBAC, or did you have a midwife? Did she carry pitocin?

Yes, it was a MW assisted birth. I was given pit and it didn't do anything as far as I know (never felt any contractions after the birth)- I still had to be transported to the nearest hospital.

The placenta was anterior but no where near my scar, it was very high.

Oddly enough, I never even felt contx while nursing this time around...I guess my uterus really was really, really tired!

I've become less hesitant to use pitocin for retained placentas after we've tried everything else.

Why?

So are you more likely to have retained placenta and/or PPH in subsequent pregnancies once you have a history of it?

[ShwarmaQueen]

Originally Posted by hillymum

I have had two retained placenta's with PPH. I was informed it was due to having fibroids.

Were they pretty obvious on an u/s? I had 4 u/s (6, 8, 20, and 36 wks) during this pregnancy and no one ever mentioned any fibroids...but stranger things have happened...

[MsBlack]

I have to wonder if maybe your placenta stayed in because of *too much* contracting of the uterus after the birth. Because you surely were contracting, at least somewhat--not all women feel those contrax, especially not immediately following the birth. And I mention this because you say that even since placental removal, you haven't had contrax--but of course you have, just not the painful kind! If not, you would have bled to death a long time ago: the placenta has so many blood vessels that help connect it to your uterus. Once the placenta separates from uterus, it is the continuing contracting/shrinking of uterine muscle that essentially squeezes shut those vessels to stop bleeding.

Could be that you were contracting so well right after the birth, your cervix closed down before placenta came out, thus making the placenta's passage much more difficult.

Some questions:

Was the placenta detached from your uterus when you had it removed? Just sitting in there, not acreta/percreta, but loose? Or did it have to peeled off the uterine wall? Do you have clear info on this? If not, I'd try to find out (your mw may or may not know--med records maybe are the best source of info).

What herbs did you take immediately following birth? Why did you take them--was it 'routine/precautionary' to try to ensure efficient post birth contrax, or was their an indicator of need such as excessive bleeding that was not receptive to nursing stimulation? (assuming those herbs were to promote contrax).

You say you had a long prodromal phase and then 14hrs active labor--were you able to keep eating and drinking throughout?

Were you able to pee fairly regularly throughout labor? Did you pee after the birth prior to transport? A full bladder can impede placenta birth, even if you are contracting...and even if the placenta has detached, can lead to inefficient contrax that aren't strong enough to help you get placenta out. Thus, you would bleed more than is good.

Did you eat anything after birth, prior to transport? I find that if mom has a drink of something nutritious (even just sweetened tea), in the first 10-15min after birth, and something to eat in the first 20-30 min, that she is far more likely to have efficient contrax for placental separation/expulsion than if she doesn't (especially if labor has been long).

Anyway, some food for thought. Having some of these answers might help shed some light. As for likelihood of repetition, I'd say it depends to some degree on the answers to these questions and how you deal next time with the issues of 3rd stage. If you are otherwise healthy, then I don't see why this would repeat--but I think some standard protocols such as uterine stimulants given routinely after birth (herbal or pit/other), delaying food, actually tend to lead to the problem you had rather than preventing it. If I see a mom who is truly exhausted after a long labor (not just 'tired'), then I might be ready to address uterine atony should that arise but well--I've seen longer prodromal labor followed by longer active labors that did not present placenta/bleeding issues.

[ShwarmaQueen]

Originally Posted by MsBlack

I have to wonder if maybe your placenta stayed in because of *too much* contracting of the uterus after the birth. Because you surely were contracting, at least somewhat--not all women feel those contrax, especially not immediately following the birth. And I mention this because you say that even since placental removal, you haven't had contrax--but of course you have, just not the painful kind! If not, you would have bled to death a long time ago: the placenta has so many blood vessels that help connect it to your uterus. Once the placenta separates from uterus, it is the continuing contracting/shrinking of uterine muscle that essentially squeezes shut those vessels to stop bleeding.

Could be that you were contracting so well right after the birth, your cervix closed down before placenta came out, thus making the placenta's passage much more difficult.

If I was contracting, I wasn't feeling them. I was bleeding quite a bit I know (enough to soak through the chux pads), well over a liter I was told.

Some questions:

Was the placenta detached from your uterus when you had it removed? Just sitting in there, not acreta/percreta, but loose? Or did it have to peeled off the uterine wall? Do you have clear info on this? If not, I'd try to find out (your mw may or may not know--med records maybe are the best source of info).

I believe the midwife said by the time the doc actually came to remove it, after all the tugging and pushing on my uterus from the demented nurse, essentially the doc just reached up and pulled in from my vagina. At some point it had detached after we arrived, but this was after a HUGE gush of blood came out and I nearly lost consciousness- the hospital was ridiculously inadequate to handle PPH- we were there for almost an hour before we were seen by the doc. I wonder if it was sitting behind the cervix, blocking that blood from coming out and then it squeezed through and thus the massive gush of blood...

What herbs did you take immediately following birth? Why did you take them--was it 'routine/precautionary' to try to ensure efficient post birth contrax, or was their an indicator of need such as excessive bleeding that was not receptive to nursing stimulation? (assuming those herbs were to promote contrax).

IIRC, Shepherd's purse. It was very shortly after I got out of the birth pool, maybe they saw I was bleeding quite a bit?

You say you had a long prodromal phase and then 14hrs active labor--were you able to keep eating and drinking throughout?

Yes, I ate up until twelve hours before he was born, but I drank labor-aid, pedialyte, juice, and water up until his birth- I stayed very hydrated.

Were you able to pee fairly regularly throughout labor? Did you pee after the birth prior to transport? A full bladder can impede placenta birth, even if you are contracting...and even if the placenta has detached, can lead to inefficient contrax that aren't strong enough to help you get placenta out. Thus, you would bleed more than is good.

I emptied by bladder hourly up to his birth, but not after his birth until I was at the hospital. I don't recall if it was before or after the placenta delivery (I know peeing in a bedpan should be a more memorable event ) I wonder...

Did you eat anything after birth, prior to transport? I find that if mom has a drink of something nutritious (even just sweetened tea), in the first 10-15min after birth, and something to eat in the first 20-30 min, that she is far more likely to have efficient contrax for placental separation/expulsion than if she doesn't (especially if labor has been long).

There was orange juice and cheese/crackers/grapes waiting for me after delivery.

Anyway, some food for thought. Having some of these answers might help shed some light. As for likelihood of repetition, I'd say it depends to some degree on the answers to these questions and how you deal next time with the issues of 3rd stage. If you are otherwise healthy, then I don't see why this would repeat--but I think some standard protocols such as uterine stimulants given routinely after birth (herbal or pit/other), delaying food, actually tend to lead to the problem you had rather than preventing it. If I see a mom who is truly exhausted after a long labor (not just 'tired'), then I might be ready to address uterine atony should that arise but well--I've seen longer prodromal labor followed by longer active labors that did not present placenta/bleeding issues.

I wasn't really that tired to be honest! I stayed active during the pregnancy and ate very well up until delivery. I thought I had covered my bases with taking Floradix, RRL, Nettle and Alfalfa in the last trimester. And I totally trust my MW's judgement so I'm not questioning whether it was something on her end...I know some things just are the way they are.

[MsBlack]

You are so right, sometimes things just are the way they are. It sounds like your mws were right on it in so many ways, and I'm glad that all is well in the end And very glad that you feel good about the mws--the best mw will see some issues from time to time, birth is just not entirely in anyone's control.

So--not meaning to 'criticize' while I apply 'critical analysis', and there really is a difference. Any event 'could have gone differently', things might have been done differently--whether or not doing things differently would have brought different results, we never know. All we can do is think about it, consider/question everything from various angles. People like to say that 'hindsight is 20-20', but I don't think that that is so often true as we like to think!

Anyway--with any birth story I will consider as many individual details as possible, with an eye to weighing what might have been done differently in case there is something to be learned for future reference. Sometimes there is something, sometimes not.

In your case, it sounds like the placenta detached pretty soon after baby's birth--or perhaps detached mostly but not entirely. And it doesn't sound like the cervix closed down fast--does seem that you were not at first contracting sufficiently. I agree that perhaps the placenta finally did release fully, and was covering the cervix, leading to that gush of blood that occurred in the hospital. Oy! You'd think staff would apply some triage skill, and get you some care ASAP instead of making you wait! I so loathe transferring care, in part because of stories like yours. I mean, we all have this idea that going to the hospital means speedy help of a sort we can't provide at home--and yet, too often it means making things worse (or just allowing things to get worse, such as letting you sit another hour with a retained placenta and blood no doubt seeping behind the cervix the whole time), before they get better.

The only thing that I think I may have done differently is to give Blue Cohosh or another uterine stimulant rather than Shepherd's Purse--which as I have read is much more for aiding blood clotting, not a uterine stimulant, and should be given only after placental delivery (Susun Weed). But I know mws have varying ideas about this herb, and I don't think of myself as any Master of Herbs by any means. And of course, that is just a shot in the dark, monday night quarterbacking as it were.

Anyway--I will say again that I don't see anything from your details that suggests to me you are at risk for another similar episode. I mean, who knows? But at least I don't hear anything that seems to be some kind of underlying problem you have, making a repeat likely. On the contrary, it sounds like you did all a woman can to set yourself up for a healthy pregnancy and birth--and all of that is probably why you have fared so well in spite of the blood loss. I try to explain to familiies--living healthy doesn't *guarantee* outcomes; living healthy is simply the best we can do to encourage healthy birth outcomes, AND, will be of great help in both short and longterm, in case of problems that do sometimes arise.

So--good work, mama

[ShwarmaQueen]

Thank you MsBlack.

[MsBlack]

anytime!

[laohaire]

Interesting thread. I clicked on it because it took me 3 hours to birth my placenta. The (homebirth, lay) midwife actively managed this stage after giving me a short while to bond with my baby.

I had a long pushing stage, 6 hours, so maybe indeed my uterus was tired out.

My contractions indeed just plain stopped after birthing.

The placenta was still attached. I felt when it detached, and was able to push it out quickly (though painfully!! I was darn sore!!) after that.

I tore during stage 2 and we discovered that when I touched my tear (by sitting on it, mostly), it would cause a contraction. So my midwife kind of made me do that over and over. It really sucked, bigtime. She also applied very careful traction. She pulled on the cord just hard enough to keep it taut but did not actually try to pull the placenta out. I can understand why she did that but I did not like it. I also hated having to sit on my tear and cause my own contractions. My midwife did not encourage me to nurse to cause contractions, and I have no idea why she didn't. (As it turned out, my baby was kind of neglected in this way overall - after I got the placenta out I went to the ER for a few hours, without baby because I was scared to bring her, to get my tear stitched up... and baby did not latch on... and it was 3 days before that was sorted out and baby was badly jaundiced and had to be hospitalized).

Anyway, I know my midwife was worried about it, but I wonder how it might have ALL turned out if she had relaxed for a while more and focused her primary attention on getting us nursing. And even if the nursing didn't do the trick for my placenta, at least my baby would have been ok, and we could have gone to Plan B (not that I wanted to go to Plan B, which was going to the ER and having them manually take out the placenta... OUCH!!!!!!!!).

[ShwarmaQueen]

Originally Posted by laohaire

My midwife did not encourage me to nurse to cause contractions, and I have no idea why she didn't. (As it turned out, my baby was kind of neglected in this way overall - after I got the placenta out I went to the ER for a few hours, without baby because I was scared to bring her, to get my tear stitched up... and baby did not latch on... and it was 3 days before that was sorted out and baby was badly jaundiced and had to be hospitalized).

Anyway, I know my midwife was worried about it, but I wonder how it might have ALL turned out if she had relaxed for a while more and focused her primary attention on getting us nursing. And even if the nursing didn't do the trick for my placenta, at least my baby would have been ok, and we could have gone to Plan B (not that I wanted to go to Plan B, which was going to the ER and having them manually take out the placenta... OUCH!!!!!!!!).

I totally understand where you're coming from. I got DS to latch and kissed and hugged him for a very short time (10 min), but it was hardly tranquil due to the urgent sense of quiet panic from the MWs, no doubt because of the PPH. I also was separated from DS for the next 4 hours and feel sad that I missed that bonding time. BUT I can't help but question what would have happened if there wasn't the active management...like what if they just left the room to let us bond and didn't moniter things... He was left with the apprentice MWs (he didn't go to the hospital either) who I just love and I know held him and loved on him, but still...

[laohaire]

I feel well bonded to DD but the nursing was not established and it had some serious consequences.

We admitted her to the hospital for jaundice at 3 days old. While we stayed in the hospital with her, she was separated from us. She was under the lights in the nursery all the time, not in the room with us. The doctor's orders allowed us to nurse only every 4 hours, which is too little. She was given sugar water without our permission, and they continued to give it to her over our objections. They discouraged us from bonding with her at all, we were allotted 15 minutes to nurse her every 4 hours on the clock, and that was IT. And even encouraged to make it faster if possible. I feel that spending even just 30 minutes being close and unstressed would have been far more valuable than the extra 1 hour a day (cumulatively) that she would have spent under the lights.

She was alone, very alone, and it broke my heart so much that perhaps coutnerintutively I left her alone more. In the beginning I'd barge into the nursery as often as I could, over the subtle discouragement of the nurses. But when I found her screaming her head off with spitup all over her (and drying, so she'd been like that for god knows how long) I couldn't take it!!! Gosh, I'm crying right now just remembering!! It was $#@ traumatic!!! And I couldn't beat to see that again, and I came less frequently. I felt like she wasn't even my baby, like I had to get permission to see her.

I swear, now that DD is 4 years old and I feel more confident as a mother, that would never happen again. DH read the story of a man who absolutely camped out with his newborn, I don't remember what the issue was (preemie, or maybe jaundice, or something) but he was damned if "they" were going to keep him away from his baby. He changed the character of the situation so well that rather than him seeking "permission" to take care of and be with his baby (his wife had a hard recovery so it was mostly him), he was granting THEM permission under his terms to take baby's temperature and so on. And saying no when it didn't suit him (like, when baby just fell asleep). DH and I agreed that if we ever found ourselves in that situation again, we'd be like that man.

It's hard for me to feel certain that DD remembers this but she has said some things that describe that she was left alone. Since the hospital she has NEVER been left alone (we don't even leave her with babysitters) so this is the only experience she can be talking about. She's 4 years old and confident and happy and yet she has a HUGE problem being left alone, we can't even just run upstairs to grab a pair of shoes without her being upset (if she's downstairs).

Sorry for hijacking, OP, I guess that just opened up some stuff for me.

[laohaire]

I forgot to say that as a result of all this I don't trust ANYONE anymore. Not doctors. And not midwives either. That's not to say I wouldn't use a midwife again (actually, I would) but I will never again just lay my trust in her anymore. I will always be in charge, if I don't feel like I'm getting the help I need I'll pick up the phone and call someone else. If I think there's a problem then I'm going to push and push until I am convinced the problem is address or completely convinced that there is in fact no problem - I'm not going to just be quieted down. I am Mama Bear now.

[Happiestever]

This was a very interesting read. I wonder why Shepherd's purse was administered instead of something else. I have always heard to take it ONLY if the placenta is out completely. Thanks for sharing your story and asking this question.