I think a 'wait and see' approach is best. It's a good tool to have on hand if bleeding looks to be quite heavy, but in the absence of a good reason it seems silly to administer to everyone.
The pitocin shot is actually standard protocol here in the UK for both hospital and homebirths.
I believe that one of the reasons for the cord traction is that a risk of using pitocin for 3rd stage management is that the cervix can shut down too quickly, resulting in a retained placenta - trapped behind the cervix - for which you would almost certainly need to transfer and possibly need surgery also. That's a pretty serious risk to take, and I wouldn't be happy taking it unless the risk of PPH clearly outweighed it.
Another thing to consider with managed 3rd stage is that it usually involves immediate cord clamping. Standard protocol is to deliver the injection as the baby's shoulders are born, so to prevent too much blood being pumped into baby's system they want to immediately clamp and cut the cord. If you were planning on delaying cord cutting that's another thing to bear in mind.
Personally I will be telling my MW that I do not want a routine shot, and do not want the cord clamped or cut until after the placenta is born, unless there are mitigating circumstances. For me that would be fairly significant blood loss - probably 750ml + and/or me feeling woozy and affected by the blood loss. In that case if the placenta still hadn't delivered I would consent to the injection. But at least that way I don't get it unnecessarily and baby will get the benefits of his/her full quota of blood from the placental system.
The pitocin shot is actually standard protocol here in the UK for both hospital and homebirths.
I believe that one of the reasons for the cord traction is that a risk of using pitocin for 3rd stage management is that the cervix can shut down too quickly, resulting in a retained placenta - trapped behind the cervix - for which you would almost certainly need to transfer and possibly need surgery also. That's a pretty serious risk to take, and I wouldn't be happy taking it unless the risk of PPH clearly outweighed it.
Another thing to consider with managed 3rd stage is that it usually involves immediate cord clamping. Standard protocol is to deliver the injection as the baby's shoulders are born, so to prevent too much blood being pumped into baby's system they want to immediately clamp and cut the cord. If you were planning on delaying cord cutting that's another thing to bear in mind.
Personally I will be telling my MW that I do not want a routine shot, and do not want the cord clamped or cut until after the placenta is born, unless there are mitigating circumstances. For me that would be fairly significant blood loss - probably 750ml + and/or me feeling woozy and affected by the blood loss. In that case if the placenta still hadn't delivered I would consent to the injection. But at least that way I don't get it unnecessarily and baby will get the benefits of his/her full quota of blood from the placental system.
