Pitocin to help birth the placenta or not?

[PoetryLover]

My last birth was a homebirth. I ended up hemorrhaging, most likely due to retained placenta, transferring to the hospital, having the placenta manually removed, needing a blood transfusion, etc. I was also separated from my DS the first 8 or so HOURS after his birth. Now, the homebirth midwife did give me pitocin when I began to hemorrhage, but the placenta still needed to be manually removed.

This time I'm birthing in the hospital. The midwife said they would probably want to give me pitocin after I birth the baby to help birth the placenta, just in case there is a replay of last time. I have to admit  that I have a bit of PTSD surrounding hemorrhaging, as I very nearly died last time. Of course, this time I will be in the hospital already, so I will lose no time in transfer (and hopefully not as much blood), and there will be a saline lock in place in case I need it. 

If the pitocin will help to birth the placenta, then I wouldn't lose all that crucial bonding time with the new babe. I seriously cried when I woke up in recovery and still had to wait HOURS to see my DS last time, while they gave him FORMULA. I'd like to prevent that.

Meanwhile, DH and I plan to have another child at some point and I was hoping for a future homebirth (if all goes well this time). But I'm afraid that if I let them give me pitocin, I won't really know if I can birth the placenta without it and may opt for an unnecessary hospital birth in the future.

Edited by PoetryLover - 8/13/11 at 12:39pm

[Baby_Cakes]

Is there a way you can just keep the option on the table?  If there seems to be a problem with bleeding, or if the placenta isn't coming out after say, 30 min, ok sure, use the pitocin, but if things seem normal, wait?  Or does it not work like that?

[SouthernStormy]

How long are they going to give you to birth the placenta before administering the pitocin? As long as you aren't bleeding heavily, I would request they wait at least an hour, as sometimes it can take that long.

Would you feel more comfortable using a herbal tincture? Since I'm having an unassisted, we ordered Angelica Root to help deliver the placenta if there is a problem. I plan on waiting around 45 mins and then play the next 15 mins by ear as to when to administer the Angelica root if I haven't delivered the placenta. We also have hemhalt on hand to stop a hemorrhage, but that can only be used safely if the placenta is already out.

[elove]

i was stopping by to see everyone else's news and saw this - still need to type up the birth story but thought i would quickly share this...so, my placenta did not want to get delivered for some reason. It was not like it was retained in the sense that it had detached but got one side still attached. It was more like I had no contractions, no cramping after the babe was out. We waited 2 hours home and during that time along w all the possible herbal stuff, my MWs administered two doses of pitocin to get my cramps/contractions going. nothing worked it just did not want to release and come out until it was good and ready

in this limited experience of mine, the only thing i can suggest it that have them explain to you why you would need pitocin...if it is to get the contractions going, that would make sense but they should be able to justify it? Also, if there is excessive bleeding - than they would probably wont be discussing it w you but going on emergency mode, right?

sorry not too much help, but still felt relavent to share. I hope you wont need any of it and it all will go smooth like butter!

[lovingmommyhood]

I can only give my experience but I've always birthed at a hospital so as far as that aspect I won't be a lot of help. I had retained placenta with my first three births. This time, on my fourth birth, I was concerned about it happening again so my OB and I discussed it at length. A bag of pitocin was hung as soon as DS was born and my OB also encouraged me to nurse. The other key factor was that he WAITED and didn't start pulling on the cord when the placenta was clearly not ready. After about ten minutes he had me push and the placenta came out, fully in tact. It's really hard for me to say if it was the pitocin, the nursing or the patient OB...maybe all three... I don't know. I'm not a lot of help I realize but I wanted to co miserate a bit and let you know history doesn't have to repeat itself! 

Best of luck!

[Italiamom]

I didn't hemorrhage per say, but with DS's birth I nearly passed out.  We waited I think 30 or 40 minutes, and at the point that I started fishing...  The midwife gave me a shot of pitocin.  The effect was almost instantaneous...  I had a strong contraction, the placenta came out whole, and I immediately felt better.

This go 'round, our plan is NO CORD TRACTION, nurse ASAP (more easily done this time, I think, now that I've spent 2 years nursing a kiddo), and if the placenta isn't out all whole and pretty in 15 minutes, then I'll have the midwife cut the cord, and give me the shot.  My main issue was that I didn't want to pass any pitocin on to this baby, and 15 minutes is about the time when cord has stopped pulsing, drained of blood, and gone cold.  Hopefully the placenta will deliver quickly on its own, but it was a scary thing in an otherwise beautiful birth with my first, and if I can avoid that trauma this time, I'm going to.

I think Lovingmommyhood's suggestion that they not pull on the cord until the placenta is already moving is key.  And I felt it moving, at which point the midwife applied traction.  But before that she didn't touch it.  I think a short wait is reasonable, and will give you enough time to pass all that blood back to the baby, in which case the cord can be cut, and you could take the pitocin.  I know a lot of mamas here would not...  I would, personally.

If you're concerned about your homebirth in the future -- don't be.  Any good homebirth midwife is going to carry pitocin,  And after this birth, if asked, you can simply report that due to your first birth you received a shot of pitocin postpartum with your second -- and had no issues.

If nothing else, I think that having the piece of mind immediately postpartum is a pretty big deal.  For me, the pitocin will make me feel less ansy about the placenta.  And anything that allows me to focus more on my brand new baby, and less on my fears about my body, is okay with me.

[HawaiianBlesing]

I don't know when you are due but you can load up on alfalfa.  I have a friend that hemorrhaged with her last two births and this time took a ton of alfalfa prior to deliver and no hemorrhage.  I also took alfalfa and nettle throughout this pregnancy and had very little to no post partum bleeding--to the point it "worried" my MW.  I've had very little lochia in fact it's almost completely gone not even 2 weeks post partum.

It's worth a shot.  If it were me, unless severe bleeding were present, I'd hold off on the pitocin and see if the placenta would deliver naturally.

[happylemon]

I agree with Italiamom, but she said it much better than I would! If your home birth midwife can administer the pitocin next time then I would be less concerned. Is there restrictions in your state about HB MWs carrying pit? I had pitocin after my first, but it was just a typical managed third stage in the the hospital, I am not sure I really needed it. My last birth went well with some herbal tinctures. This go around I already told my midwives I will certainly accept pitocin if it is needed, I don't want to mess around and risk loosing too much blood. I also agree that asking your midwife/OB to wait and not pull the cord is a biggy.

[myorianna]

I delivered at a hospital and just wanted to chime in- I had talked to my ob about the Pitocin for delivering the placenta as I had heard that if you breastfeed right after the delivery, your body's natural oxytocin should be just as effective.  My ob said that the reason she gives Pit is not for the placenta but as a means to prevent hemorrhaging.  I had still wanted to try without it, but unfortunately needed a small dose of Pit to augment my contractions so I didn't get to try it out on breastfeeding alone.  My birth plan had that I didn't want it unless breastfeeding was not possible immediately after the birth, so you may be able to ask for that as well.