Managed 3rd stage... studies?

[turnquia]

I'm looking for studies on managed third stage on being safer or more effective, especially for those at higher risk of a PPH.

(we're having twins, and this is one of the things up for discussion with the OB)

Pit drip after the twins are born, before placentas.

I'm looking for risks, benefits etc. preferably any evidence based studies!

Thank yoU!

[MegBoz]

Sorry, I don't have links to studies, but I know WHO recommends 3rd stage active management.

I know PPH is more likely in cases where labor was extra long, or labor was induced or augmented with pit. I also believe cord traction or manual placenta extraction increase the risk.

Considering all those things are more likely to be done in an average American hospital birth, I'd be really curious to see what the PPH risks are in an evidence-based birth. In other words, is PPH risk really so high that prophylactic active management is the best practice, across the board? I'm inclined to doubt it. So I'd love to see data split out.

[Mama Metis]

Congrats on your twins!

Active management of the third stage of labor is indeed "evidence based" even for a low-risk singleton birth, because it has been shown to reduce overall blood loss. That said, anytime you intervene in a natural process as complex as childbirth, unintended consequences are always possible, although I'm not aware of any that are documented through a study.

Here's a link: http://www2.cochrane.org/reviews/en/subtopics/87.html I can't link directly, but click "Pregnancy and Childbirth" > "Normal Birth" > "Third Stage" > "Prophylactic oxytocin for the third stage of labour"

Also, here's a recent thread with some other relevant links and discussion: http://www.mothering.com/discussions....php?t=1258454

[turnquia]

Thank yoU! I will read those in a bit. For my OB no cord traction or manual extraction of placenta, but they want a pit drip up for after the birth of both babies... I haven't had pit ever and experperienced an anaphylactic reaction to fenugreek after my DS was born (he was 3 months old)... and lol adding new meds freaks me out!

But given the added risk of a bleed with twins, I'd like to also discuss this with homebirth midwives (because we are planning a homebirth, and yes OB knows this). We want to make sure we are safe at home. Even if active management here involves maybe some herbs or tinctures to help after the birth of both babies.

lol am I making any sense?

[turnquia]

So Active management of 3rd stage involves pit, PLUS immediate cord clamping and when signs of placenta detachement cord traction, plus maternal assistance.

Would there be any downfalls to just pit, holding off on cord clamping until pulsing is done and then continuing to do active management. Cord traction isn't as huge of a deal if your 100% confirmed the placenta has detacted.., lol nor is the mother just getting up and pushing it out.

I'm not cool with immediate cord clamping... the pit doens't seem to bother me so much especially if its evidence based.

[kltroy]

Don't think there's any reason you can't delay cord clamping and otherwise do a managed 3rd stage. In my own birth from 2 years ago I specified a time (5 minutes) rather than a criterion ("until cord is done pulsing") for the delay -- I figured it was more likely to be followed, since it was less subjective. An OB friend of mine says she routinely "milks" the cord to push the blood that is within it to the baby. She finished her residency about 3 years ago, so this may be the compromise that OBs have come up with to give baby the benefit and not have to wait around, since they're impatient. Anyway, these all seem like questions you can ask your doctor. The one thing I would definitely suggest would be to have someone like your mom or husband designated to REMIND you and your doctor of these types of details during the birth itself. You all may have the best intentions, but if you're off in lala land at that moment (and heck - you will have just had a baby -- why wouldn't you be??) then you may not remember and doctor may be flying on autopilot.

ETA - see you're planning a HB -- again, just talk the whole thing through with your MW and see what makes sense with her. I still think reminders at the appropriate time points are they key to having ANY birth plan followed.

[turnquia]

Originally Posted by kltroy

Don't think there's any reason you can't delay cord clamping and otherwise do a managed 3rd stage. In my own birth from 2 years ago I specified a time (5 minutes) rather than a criterion ("until cord is done pulsing") for the delay -- I figured it was more likely to be followed, since it was less subjective. An OB friend of mine says she routinely "milks" the cord to push the blood that is within it to the baby. She finished her residency about 3 years ago, so this may be the compromise that OBs have come up with to give baby the benefit and not have to wait around, since they're impatient. Anyway, these all seem like questions you can ask your doctor. The one thing I would definitely suggest would be to have someone like your mom or husband designated to REMIND you and your doctor of these types of details during the birth itself. You all may have the best intentions, but if you're off in lala land at that moment (and heck - you will have just had a baby -- why wouldn't you be??) then you may not remember and doctor may be flying on autopilot.

ETA - see you're planning a HB -- again, just talk the whole thing through with your MW and see what makes sense with her. I still think reminders at the appropriate time points are they key to having ANY birth plan followed.

LMAO! I don't get to be off in lala land enjoying my baby I have to push out another one!! ACK! (Still wrapping my head around this logistic).

But yes... all birth support will be aware of plans and wishes prior to delivery. Even the OB. as there will only be ONE ob attending... since the others in his practice think i'm nuts (well they won't delivery breech twin, or vaginal twins)

[loveneverfails]

Not a study, but a mom with a history of PPH and active management 3rd stage was a tremendous help, and I will personally never plan expectant management again. I had so much more energy and felt physically so much better having had the shot of pit prophylactically. For me, it was a very very good call.

[turnquia]

Originally Posted by loveneverfails

Not a study, but a mom with a history of PPH and active management 3rd stage was a tremendous help, and I will personally never plan expectant management again. I had so much more energy and felt physically so much better having had the shot of pit prophylactically. For me, it was a very very good call.

ETA I'm glad it was helpful for you I know here many tend to be against a lot of interventions but realisitcally i'm having twins, I expect some interventions to be necessary or at least beneficial.

Well I just spoke to midwife and we're going to talk more about this at next visit. But I think especially since its a homebirth and we are a tad bit further away from hospital that we need to come up with a good plan for this. And even if our 3rd stage management involves herbs or tinctures or heck the shot of pit and then relaxing for the rest, then so be it. So we'll see where we get. There is good enough data that soem active management is helpful, while parts of it has its drawbacks (like immediate cord clamping). So we will work to find a plan that makes all of us happy