pit after the birth - Page 2

[IdentityCrisisMama]

Good article TB.  It's really a lot to think about because I think many homebirths (at least most of the ones I know about) do not necessarily follow Odent's protocol.  And, I must admit that it seems a bit challenging to accomplish.  I had planned on having my close family (9 year old DC, DH, perhaps mother) in the room bonding with me and the baby shortly after birth.  It's difficult to imagine asking DC & DH to sit in the shadows.  :-(    Perhaps a job for everyone immediately following the birth would be a good idea.  Warm, however, is not something I've put much thought into and a space heater on the ready is an easy thing to achieve.  

I still haven't decided what I am going to do regarding PIT.  It is by no means required by my MW but I did have a PPH (treated by uterine massage) and, while I do not think my life was in danger, recovery was a PIA and weighing the risks/benefits is not so cut and dry for me.  

Also, most of the articles I've read address the issue of the "active management of the 3rd stage protocol" as a whole and not JUST the use of profilactic PIT or PIT as a treatment for PPH. 

Top that off with the fact that I still can't find any good info on whether or not PIT is more effective if used before signs of a PPH or if it works as well/well enough as a treatment (I have read that it is far more effective if used before but have not found any good info to either back that up or dispute).  Anyone have any info on this?  

Aliy, did you get any more info from your MW?     

[Tumble Bumbles]

ICM, I totally understand. It's difficult to imagine not having your husband and child, mom or whoever you choose to witness your birth be part of the special immediate period after birth. I don't think Michael Odent was trying to alientate anyone  ( I know you didn't say that!) but that he was purely speaking of the physiological chemical/hormonal reaction and doing what he felt based on his knowledge, experience, and observation would best promote the releasing of optimum levels of oxytocin in order to most effectively prevent pph. To me, it's worth it and I would hope no one would feel alienated or left out by allowing me several minutes of just me and new baby time. I don't necessarily think people need to leave you alone completely, but sort of just allow that initial ~sphere~ around you and your babe before coming into the circle.

The heat thing is a big one - I had my last babe in the summer and I remember my midwife turning off the a/c about 2 hours before I gave birth. By that time it was about 88 degrees in my house but I felt great and didn't shiver at all afterward (while dh and my mom were sweating lol).

A lot of pph happens due to mismanagement of the placenta birth to my understanding -- cord traction, rushing the placenta, interrupting oxytocin release before placenta is out etc. I think Pit is used before pph not so much to prevent pph (well, secondary) but to cause contractions in order to hurry and rush that placenta out. I think one main problem that leads to pph is changing the entire mood surrounding the third stage. It's like, let's be zen and peaceful and supportive of mama (ideally) until baby's born but once baby's out B A M LET'S GET THAT PLACENTA QUICK ITS THIRD STAGE WE NEED ACTION HERE PEOPLE seems to be the vibe (even if nothing is actually said...this happens in homebirths too). I think that alone can contribute to pph because mama's adrenaline interrupts oxytocin release.

[Plaid Leopard]

Here is the Michel Odent article "The First Hour Following Birth: Don't Wake the Mother!"

http://www.midwiferytoday.com/articles/firsthour.asp

[IdentityCrisisMama]

Hey, PL!!   Long time no see!!  That hyperlink brings you right back to this thread but I'd like to read it.  I'm still struggling with the idea that an hour will feel like an eternity to DC.  

Another thing I'm thinking is that when PIT is given should be maybe more specific -- I am considering PIT at the time of my PPH, which was after the birth of the placenta so I don't expect the whole rush thing.  

I am leaning against it at this point or at least against it if my birth goes more smoothly than last time.  

[IdentityCrisisMama]

Here is that article: http://www.havingababytoday.com/articles/firsthour.asp

[Plaid Leopard]

Hey ICM!

I fixed the link (I hope).

I had a PPH after my second birth. The midwife told me I didn't have to bleed, asked me to tell myself to stop bleeding, and then and gave me drops of Shepherd's Purse tincture. And I stopped bleeding. The MW said that she often sees PPH in women who need extra emotional attention and support after the birth. Obviously there is a physical reason for bleeding, but perhaps the emotional state contributes in some cases.

At a birth I attended as an apprentice, the woman was bleeding, didn't respond to Shepherd's Purse, so the MW gave an injection of Pit, which stopped the bleeding within a a couple of minutes.

I was just reading a discussion onstudent midwife board about active versus physiologic management of third stage. Sarah Wickham wrote an article in 1999 suggesting that "overall blood loss by 36 hours is similar with active or physiological management. It seems that while oxytocics may appear to reduce blood loss at delivery, when the action wears off on the postnatal ward, Lochia loss is heavier.

Wickham (1999) observed that following active management women often experienced a heavy blood loss when going to the bathroom for the first time on the postnatal ward. She suggests this heavy loss does not occur in women who have had expectant management."
Reference:
Wickham S (1999) Further thoughts on the third stage. Practising Midwife 2(10): 14–15. Cited in: Harris T (2001) Changing the focus for the third stage of labour. BRITISH JOURNAL OF MIDWIFERY. 9 (1), pp.7-12.

[Plaid Leopard]

Originally Posted by IdentityCrisisMama 

Here is that article: http://www.havingababytoday.com/articles/firsthour.asp

thanks! I've got a grabby 3 year old who is preventing me from doing much of anything here!

[IdentityCrisisMama]

Originally Posted by Plaid Leopard 

Hey ICM!

I fixed the link (I hope).

I had a PPH after my second birth. The midwife told me I didn't have to bleed, asked me to tell myself to stop bleeding, and then and gave me drops of Shepherd's Purse tincture. And I stopped bleeding. The MW said that she often sees PPH in women who need extra emotional attention and support after the birth. Obviously there is a physical reason for bleeding, but perhaps the emotional state contributes in some cases.

At a birth I attended as an apprentice, the woman was bleeding, didn't respond to Shepherd's Purse, so the MW gave an injection of Pit, which stopped the bleeding within a a couple of minutes.

I was just reading a discussion onstudent midwife board about active versus physiologic management of third stage. Sarah Wickham wrote an article in 1999 suggesting that "overall blood loss by 36 hours is similar with active or physiological management. It seems that while oxytocics may appear to reduce blood loss at delivery, when the action wears off on the postnatal ward, Lochia loss is heavier.

Wickham (1999) observed that following active management women often experienced a heavy blood loss when going to the bathroom for the first time on the postnatal ward. She suggests this heavy loss does not occur in women who have had expectant management."
Reference:
Wickham S (1999) Further thoughts on the third stage. Practising Midwife 2(10): 14–15. Cited in: Harris T (2001) Changing the focus for the third stage of labour. BRITISH JOURNAL OF MIDWIFERY. 9 (1), pp.7-12.

I'm running out but wanted to catch you (time zone and all).  I had read a few comments about PIT working better as a profilactic than as a treatment for PPH after it had begun.  I'm glad to hear it works well in some cases.  Any idea if it typically works well as a "last resort" after other less invasive methods are used?  I do have Shepherd's Purse at home (haven't made the tincture yet).  Is that something you would consider as a profilactic after the birth of the placenta?  Perhaps I should also keep in mind that uterine massage DID work for me...but I had already lost quite a lot of blood by the time we tried it.  It was just SUCH a bummer to be so tired, yellow and pathetic after the birth.  I don't want that again...I want to be plump and rosy!  
 

[Plaid Leopard]

Yes ICM - I believe Pit works well as a "last resort". I'll search for some links. Obviously, it would depend on the amount of bleeding. If a woman is gushing vast amounts of blood I imagine pit would be a first choice. If it is a slower but persistent trickle then there would be more time to try other methods such as uterine massage, shepherd's purse, plaving a bit pf placenta between gum and cheek etc...

[MoonJelly]

*subbing*  I had to have a pit shot after my HB because of excessive bleeding--the only thing that truly scared me during my HB. Hoping to learn more about PPH before my next HB... 

[Youngfrankenstein]

Originally Posted by Chloe'sMama 

I have never heard about it administered at a HB without need.  My MW said she brings it just in case, but has only had to use it a few times out of hundreds of births (mine was not one of them....)

I wouldn't let them, unless there was evidence of excess bleeding after birth.

This is what I was thinking.  It never came up for me although I knew my mw carried pit to births in case it was needed.  Could she be more specific if it has to do with your bleeding last time?  If you love everything else about your mw, I may let this slide if I felt totally confident in her otherwise.

[loveneverfails]

I tried active management of 3rd stage with prophylactic pit in my last birth, and it was the single best decision I've made for my births regarding any intervention.  PPH ruined a previous babymoon for me, and I went with the pit and it was an incredible difference.  I will absolutely choose pit with every birth.  I will not ever wait until after I've bled to anemia to get a shot to stop bleeding.  I think the Cochrane review is very clear on its merits, and it was an absolute game changer for me in a very positive way, especially with my baby needing emergency transfer.  

Go Team Prophylactic Pitocin!  May not be "crunchy" but heck... it works for me!  

[CookAMH]

This is a really interesting thread and I'll be talking to my midwife about it next week. I enjoyed the first Odent article.

My midwife has observed that precipitous labors seem to make up a decent portion of PPH, perhaps at least in her experience. This was the case with a friend of mine in another state too, with her birth in January (and midwives there can't give PIT so she had to transfer) that was fast and furious. My midwife has pit and methergen (sp).  It is very tempting to lean toward prophylatic use of it for me in order to (perhaps) reduce the possibility of a transfer. This is our first homebirth, and I'm a VBAC so I would not be accepted as well at hosp as a result.  That can significantly affect the immediate post partum period.

That is interesting what was said above about lochia being heavier later, that as a whole, the bleeding was the same.

[IdentityCrisisMama]

Originally Posted by loveneverfails 

I tried active management of 3rd stage with prophylactic pit in my last birth, and it was the single best decision I've made for my births regarding any intervention.  PPH ruined a previous babymoon for me, and I went with the pit and it was an incredible difference.  I will absolutely choose pit with every birth.  I will not ever wait until after I've bled to anemia to get a shot to stop bleeding.  I think the Cochrane review is very clear on its merits, and it was an absolute game changer for me in a very positive way, especially with my baby needing emergency transfer.  

Go Team Prophylactic Pitocin!  May not be "crunchy" but heck... it works for me!  

Could/would you share more about the management of your third stage.  Was prophylactic pit the only intervention or was that combined with other things (extraction of placenta, uterine massage)?  I am in a similar place as you - disappointing babymoon.  I'm leaning away from prophylactic pit - under all circumstances and more towards requesting that it be given if I have a birth that leads the MW to think I have greater chance of PPH (in my case another LONG second stage).  I am also feeling like even if I do get prophylactic PIT I would like it after I deliver the placenta (trying Odent's suggestions).  Did you get yours before the placenta or after?   Another thing is that I did know there was something wrong at the end of DC's birth.  I had delivered the placenta and just KNEW the birth wasn't over before there were any outward signs of PPH.  If feel like if I honor this feeling I'll be able to catch it (and get PIT, or some other remedy) earlier than last time.  

Did you have a similar experience with your PPH?  What did they do for yours?  How long did you bleed before it was managed?  

[loveneverfails]

My placenta came very fast this last time, so it was pit after placenta although I requested pit before the placenta.  I did have a bleed before where the blood was all behind the placenta, so it wasn't visible, so we didn't know I needed the pit until I'd lost a good amount of blood, and that was with a picture perfect labor and a short pushing time.    

I didn't want to put the burden for the "are we trending towards too much blood loss" intuitive sensing on me or on my care team when the risks of a shot of pitocin are so so so low, and the potential benefits so high.  You can have all the best intentions in the world of honoring that feeling that something isn't right, but what if your baby is a little slow to start?  If that happens, you're not really thinking about how you feel (generally) because you're worried about your baby, and it's very easy for things to slide under the radar and then two of you need help.  And, having been through the emergency transfer with a newborn, I know how much minimized blood loss kept me going.  I was awake from labor starting at 2:30am to getting home with my daughter in the NICU at 10pm, and able to advocate for her and have a strong milk supply because my recovery wasn't an issue.  And the chance of having a situation like that is low, but faced with that reality I was so grateful that I had just gone for the pit.  I needed every bit of my strength in that emergency scenario, and I don't think that I'd regret having more energy from minimizing blood loss by taking a shot of pit so that I could hit blood loss right off the bat and then not worry about it. 

Compared with the minor nuisance of dealing with an injection, it is *so* worth it to me to not worry about "will I bleed?"  With the shot of pit, you are guaranteed to lose less blood than without it (per Cochrane) and if you actually *do* have a problem going on, I'd rather know about it sooner rather than later to preserve blood.  I know not everyone feels that way, but I am moving very much towards being more amenable to medical intervention, particularly when it is *such* a minor deal.  It's just a shot.  I can take a shot to give myself a better chance of avoiding blood loss severe enough to make recovery miserable, because if there is a good chance that I'm winding up with the pit anyways, I'd rather it be before bleeding to anemia.  It bothers me to think that if this was an herb "pitocinia" that we took sublingually to strengthen post birth contractions to prevent PPH, many people would probably be all over it, even in natural circles.  I know of a lot of people who take alfalfa supplements to try to prevent bleeds.  And it really is just a stupid shot that burns for a little bit and then it's over and your bleeding is down potentially quite a lot.  

I would rather have minor interventions to bring things in my birth more towards an optimal level than run a good chance of less optimal results so that it was purely "natural" and something that my body did on its own.  It is a philosophical issue largely at this point, because the medical evidence according to the Cochrane reviews is very strong.