Oh placenta...

[lovingmommyhood]

DS 1 -2004 Induced with cervadil two weeks early due to high blood pressure/low fluid.
-Labored for 7 hours
-Walking epidural
-Weighed 6 lbs 11 oz
-Aged "ratty" looking placenta (their words on my chart) that was manually removed. (He stuck his arm up inside of me several times to pull it out. AFTER he tugged on the cord and it broke.

DS2 -2006 Went into labor on my own on his due date.
-Labored for 4 hours
-Epidural (would've gone naturally but I was so terrified that another manual removal was in my future)
-Weighed 7 lbs 9 oz
-Aged placenta, removed with tools...came out in chunks.

DD1 -2008 Water broke at 36 weeks 6 days.
-Didn't go into labor on my own...made the mistake of going into the hospital...they started pitocin six hours later and I didn't start contracting until I was at the highest allowable dosage.
-"Labored" or it took me four hours to dilate fully.
-Epidural
-Weighed 6 lbs
-Aged placenta, removed with tools...she inserted something into my rectum to help it come on it's own but I still feel she only waited ten minutes at the MOST before going after it. I did have quite a bit of bleeding right before I began to push my daughter out.

Okay...so. I really want to have a natural delivery. I've always wanted that and it seems like it will never happen because of these issues. A thought does cross my mind though. With the first delivery...my ob was horrid. I was given a shot in my thigh right after delivery which I now know is to make your uterus contract but also causes your cervix to close...thus the need to get the placenta out grows. He didn't even wait five minutes before pulling on it...followed by the torture of him shoving his arm up there. So I'm wondering if the fact that this happened has made my other OB and CNM think that meant it was a problem so their view of the delivery was already tainted. Neither waited over ten minutes to go after the placenta. I just feel they assumed it wouldn't come out so they just decided better to go get it. After all I already had pain meds...

But I don't WANT to take pain meds for my next baby. I have fast, easy deliveries. With my son I didn't even hardly feel contractions until I was an eight. I'm just so terrified of the pain of the manual extraction that I can almost not even focus on the labor pain because I know the pain at the end will be so much worse. And I can't hold my baby if I'm screaming and bucking in pain. *sighs*

ANYONE have experience with this? Any input? Ideas? Help?

TIA

[sarahn4639]

You either need to find a provider who does not practice active 3rd stage and discuss this at length with them. Include things like; I refuse any 3rd stage intervention unless there is an active hemorrhage, or I will wait a minimum of 20 (or 30) minutes before discussing any 3rd stage intervention, or some other clear and defined limit. You need someone that knows how strongly you feel about this and is on board to respect that.

That said, your best bet is a home birth. It will be most conducive to getting the natural birth you want, ie no pit, no cervidil, no epidural. But you could still go in if there was need. Also, you are going to have a provider that is, on the whole, less interventive, especially with 3rd stage. They don't want to risk causing a hemorrhage by forcing early separation but still carry the meds just in case.

[lovingmommyhood]

Am I at a high risk for a hemmorhage because of my past history? With DD one there was a large rush of blood before I had her which did frighten me some but maybe is normal, I'm not sure? The CNM said "We have to get her out, NOW" So the whole time I was just a little freaked out.

I would love to do a homebirth more than anything but unfortunately I live 20 miles from any hospital and 90 miles from the hospital I would go to. The one 20 miles away is AWFUL and I won't even take my kids there any longer.

I feel like I have bad placentas...but part of me thinks that it's more the care providers that are being over zealous in going after them. I don't want to be stubborn and make them wait for it only to have to go in to have it removed in surgery. Arg. I'm so confused.

[Pirogi]

You don't make "bad" placentas. You make excellent placentas that work wonderfully and have grown three healthy babies. And as far as "aged" placentas ... well perhaps they had more calcifications or whatever. But I wonder sometimes if labels like this are used as a defensive mechanism by HCPs to justify induction or other interventions.

As for your further chances for hemorrhage ... without more history, it would be difficult to say. It may be simply that you take a little longer than average to birth your placentas. Do you know if you ever had any abnormal placental attachment issues (for example, placenta accreta, placenta increta, placenta percreta)? Do you have any other history of uterine surgery? Have you had a hemorrhage? Officially a hemorrhage is more than 500 mL of blood after a vaginal birth, but keep in mind that the definition changes to 1000 mL for a cesarean birth. Presumably a woman having a cesarean would be in a hospital where she could be monitored and given a transfusion if necessary, but I would imagine that if a woman can be "ok" losing 1000 mL after a cesarean, then a woman would also be "ok" after losing that amount after a vaginal birth. Hemorrhage is tricky, because the shock that is sometimes associated with blood loss is tricky. Some people can lose more blood and not feel shocky; some people can't even lose 500 mL before their body starts going into shock.

I would agree that your best bet is to talk with a healthcare provider about having a natural 3rd stage. I don't know about your area, but I have actually never met a hospital-practicing HCP that was comfortable waiting for a woman's body to naturally finish the birth process. You may indeed need to look into out-of-hospital options.

Really you have two different issues here. The first is hemorrhage, which most competent midwives can handle at home, or know when to transfer when it becomes a true medical issue. There are many natural (herbs, external uterine massage, placentophagy) and pharmaceutical (pitocin, etc) methods to control mild to moderate bleeding. The second is the birth of the placenta. Sometimes women just take longer to birth the placenta (and yes, I would agree that 10 minutes is not very long at all. I had a natural third stage with my first, and my placenta did not deliver in the first ten minutes following birth). See how comfortable your HCP is with waiting, if you are not bleeding heavily.

With the information you have given, I do not think these issues would preclude you from having a "natural" birth. A question for you, though ... by "natural delivery," are you considering still having induction, epidural, etc? My opinions above are based on a mom who doesn't have these things, since that is my experience and area of study. I do not know if it would be even advisable to consider a natural third stage with an induced labor or after using epidural drugs. I am ignorant in these issues.

[MegBoz]

Originally Posted by sarahn4639

You either need to find a provider who does not practice active 3rd stage and discuss this at length with them
<snip>
That said, your best bet is a home birth.

ITA