thanks for explaining. I'm another mom who came across this. i cant rememeber if i had this done after my 1st two. There was U psuhing but not like ur saying. my 3rd was a c section.
active management of third stage also includes pit and pulling on the cord to yank the placenta out. should both of those procedures be part of every birth as well???
It doesn't advocate pulling on the cord to yank the placenta out. It advocates gentle cord traction with Brandt maneuver to deliver the placenta in a timely fashion.
Yes, I believe both of those should be a part of every birth as well, especially something like a UC. When you UC, you're essentially giving birth as if you are in a third world country so you need to do everything you possibly can to avoid excessive bleeding. A shot of IM pit and gentle cord traction with fundal massage after the delivery of the placenta can all help you avoid PPH, which very well could cause you to bleed excessively and affect your milk supply.
Because women in America who uc have to walk for hours to access emergency care and are malnutritioned. And who is going to admin the pit???
So, again where are your studies showing interferance is nessacery at *every* single birth?
Why would a woman who had a successful UC, (baby born ok), be in more need of active management for 3rd stage? I mean, everything worked right up to that point for baby to be born, no medications/interventions... and yeah, you can go to hospital if pph...? If I had problems birthing placenta, the last, last thing I would ever do is pull on cord. I would have gone to hospital. If there were chunks missing or I was bleeding heavily, I would've gone to hospital.
I understand WHO is making world recommendations, but I am getting really sick of the comparisons between complications/outcomes for women who hb/uc to women giving birth in war torn, famine stricken nations with no or little medical access. There are far, far too many other variables to make those things comparable. Education, resources, prenatal care, access to medical care, nutrition, clean water, hygenic birthing supplies, not to mention in a lot of worst birthing nations there are issues of FGM, abuse, teenage pregnancy, etc.
For what it's worth, I did have my UC in what considered a "3rd world country" - one with a 90% c/s rate for women with private insurance, which of course was a major motivator in having baby at home.
I read this just a little after I posted this morning.... http://www.huffingtonpost.com/robin-lim-cpm/birth-on-the-edge_b_1412505.html
Robin Lim (CPM working in Bali) states "Fortunately, we are able to give each expectant mother prenatal vitamins, due to the generosity of our friends at New Chapter (vitamins) in Vermont. Even so, it's an uphill battle against malnourishment and the impact of one of its main culprits "New Rice," a strain of high-yield white rice that has replaced the nutritious red rice that was once the staple food of this region. It's now a leading factor in the alarming rate of women hemorrhaging after childbirth." (emphasis mine)
Why should women who are healthy and showing *no* signs of pph be treated in the same manor, with interventions that are not without their own risks, as women who are impoverished and malnourished???
I wouldn't recommend the cord traction part to a UCer. IMHO it's too likely to lead to partial separation of the placenta---> hemorrhage. It's not always obvious when the placenta has completely separated. With a UC, if the placenta isn't coming by itself, it's time to go to a skilled care provider with tools at hand to manage a hemorrhage.
It doesn't advocate pulling on the cord to yank the placenta out. It advocates gentle cord traction with Brandt maneuver to deliver the placenta in a timely fashion.
Yes, I believe both of those should be a part of every birth as well, especially something like a UC. When you UC, you're essentially giving birth as if you are in a third world country so you need to do everything you possibly can to avoid excessive bleeding. A shot of IM pit and gentle cord traction with fundal massage after the delivery of the placenta can all help you avoid PPH, which very well could cause you to bleed excessively and affect your milk supply.
"Gentle cord traction to deliver placenta in a timely fashion" should be a part of every birth??? Especially a UC???? Are you joking me? I would slap somebodys face if they yanked on my cord after delivery. That's insane. The placenta will deliver itself in most cases when left alone and advising women in a UC situation to pull on the cord after a normal delivery is just crazy.
"When you UC, you're essentially giving birth as if you are in a third world country" - ummm, what the hell do YOU think it is, that separates the way we are living, from the way people in third world situations are living?? Because I can promise you, it's not the absence of a flat screen TV and some fritos to munch on. We're talking about possibly severe, generations long malnourishment, possible underlying untreated disease, possibly filthy conditions, possible outbreaks of pretty crazy illness around the pregnant mother...and that's just a beginning list. On what planet are you living, that you think a woman having a UC is in any way, shape or form giving birth as if she were in a third world scenario?? That's just obscene, insulting and completely naive.
I read this just a little after I posted this morning.... http://www.huffingtonpost.com/robin-lim-cpm/birth-on-the-edge_b_1412505.html
Robin Lim (CPM working in Bali) states "Fortunately, we are able to give each expectant mother prenatal vitamins, due to the generosity of our friends at New Chapter (vitamins) in Vermont. Even so, it's an uphill battle against malnourishment and the impact of one of its main culprits "New Rice," a strain of high-yield white rice that has replaced the nutritious red rice that was once the staple food of this region. It's now a leading factor in the alarming rate of women hemorrhaging after childbirth." (emphasis mine)
Why should women who are healthy and showing *no* signs of pph be treated in the same manor, with interventions that are not without their own risks, as women who are impoverished and malnourished???
Right!?
there are studies showing that active management of 3rd stage has better outcome, but there are serious questions about how well done those studies are. and for what it's worth, I had one hospital birth with active management, one home-birth without. I bled considerably less, both right away and long term, without active management.
there are studies showing that active management of 3rd stage has better outcome, but there are serious questions about how well done those studies are. and for what it's worth, I had one hospital birth with active management, one home-birth without. I bled considerably less, both right away and long term, without active management.
The thing which seriously skews the statistics for me, re: active management in the third stage of labor, is the fact that the first two stages are SOOO over "managed" in so many births these days. What percentage of women receive some type of labor augmentation now-a-days in the form of pitocin or whatever else? Isn't it like 80-85% or something? I'm sorry but, in my mind, there is a complete and undeniable difference between the needs in the third stage of a woman who has had a normal delivery and the needs of a woman who has had her labor pushed along and physiologically altered by powerful drugs.
I do not believe that a uterus which labors in its own time, in a comfortable and natural manner, will need much help in most cases. A "one size fits all" approach fails every time. For some it's too much, for others not enough...but then the medical model is just famous for that, isn't it? Drives me bananas.
"Gentle cord traction to deliver placenta in a timely fashion" should be a part of every birth??? Especially a UC???? Are you joking me? I would slap somebodys face if they yanked on my cord after delivery. That's insane. The placenta will deliver itself in most cases when left alone and advising women in a UC situation to pull on the cord after a normal delivery is just crazy.
"When you UC, you're essentially giving birth as if you are in a third world country" - ummm, what the hell do YOU think it is, that separates the way we are living, from the way people in third world situations are living?? Because I can promise you, it's not the absence of a flat screen TV and some fritos to munch on. We're talking about possibly severe, generations long malnourishment, possible underlying untreated disease, possibly filthy conditions, possible outbreaks of pretty crazy illness around the pregnant mother...and that's just a beginning list. On what planet are you living, that you think a woman having a UC is in any way, shape or form giving birth as if she were in a third world scenario?? That's just obscene, insulting and completely naive.
Yes, I believe gentle cord traction to deliver the placenta in a timely fashion should be a part of every birth. No, I do not think it should be a part of a UC birth as I don't think anyone should ever UC. Without training on how to appropriately apply gentle cord traction, you're liable to just rip the cord right off the placenta and then end up with needing a manual extraction, which no doubt you would try to do on yourself and that would just be a disaster. So, in my perfect world, no one would UC and everyone would get gentle cord traction. I believe in evidence based practice. I have been trained in evidence based practice. The evidence clearly states that active management of third stage leads to superior outcomes. To reference, I will refer you to the WHO (as was stated previously), as well as the International Confederation of Midwives (http://www.internationalmidwives.org/Whatwedo/Programmes/POPPHI/PostPartumHaemorrhage/tabid/339/Default.aspx).
Well OP, I guess that answers your question... no fundal massage is not always necessary, (and cord traction, pitocin, etc.), and yes, some obgyn/mw/nurses will do it anyways, as they are "trained in evidence based practice" - which may include evidence that you do not agree with or has nothing to do with your personal medical/birth/health situation.
I suggest you ask your hcp about their views of 3rd stage management.
Yes, I believe gentle cord traction to deliver the placenta in a timely fashion should be a part of every birth. No, I do not think it should be a part of a UC birth as I don't think anyone should ever UC. Without training on how to appropriately apply gentle cord traction, you're liable to just rip the cord right off the placenta and then end up with needing a manual extraction, which no doubt you would try to do on yourself and that would just be a disaster. So, in my perfect world, no one would UC and everyone would get gentle cord traction. I believe in evidence based practice. I have been trained in evidence based practice. The evidence clearly states that active management of third stage leads to superior outcomes. To reference, I will refer you to the WHO (as was stated previously), as well as the International Confederation of Midwives (http://www.internationalmidwives.org/Whatwedo/Programmes/POPPHI/PostPartumHaemorrhage/tabid/339/Default.aspx).
Oh...now I understand. I totally understand. I'm a woman without a "MD" behind my name...so I'm an effing idiot when it comes to birth and shouldn't believe that I have what it takes to do it myself, despite the fact that many, many women have very wonderful, completely safe UCs all the time. Those women are all just "lucky". Preparation, research and individual skill/knowledge base have nothing to do with their success. ;) End of story!
Clearly there is nothing I could say to you and nothing you could say to me, that would put the two of us seeing "eye to eye" when it comes to birth. Just to make you aware, the bolded was incredibly frustrating and insulting to read. I don't know if you meant it to be or not..so, whatever. For the sake of saying it: UC birthers are not anywhere close to the idiotic monkeys asses you, apparently, believe them to be. Your dearly loved Medical Community and their "Evidence Based Practice" do/say/believe idiotic things all over the place. There is no one magical way to birthing success.
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Clearly there is nothing I could say to you and nothing you could say to me, that would put the two of us seeing "eye to eye" when it comes to birth. Just to make you aware, the bolded was incredibly frustrating and insulting to read. I don't know if you meant it to be or not..so, whatever. For the sake of saying it: UC birthers are not anywhere close to the idiotic monkeys asses you, apparently, believe them to be. Your dearly loved Medical Community and their "Evidence Based Practice" do/say/believe idiotic things all over the place. There is no one magical way to birthing success.
For me, this thread just reaffirms uc as viable option... and stresses how important it is to know exactly who/what you are getting when choosing a hcp. If I am going to pay hcp for pregnancy/birth, I want them to make decisions about care for ME and I want them to have the expertise to know when something is actually needed or not, (not assume my uterus is going to fail at everything, all the time!)
Kinda reminds me of when you have internet troubles and call for help - talking to a real, attentive person, or getting one of the people reading off the screen - did you do a, please try b... now do c --- when x, y, z is the real issue!!
As far as all the "evidence based" backhanded insults being slung around mdc, here is an interesting article written by Union of Concern Scientists about how a lot of the times your evidence is corrupted - http://www.ucsusa.org/assets/documents/scientific_integrity/how-corporations-corrupt-science.pdf
It has nothing really to do with birth specifically but does address a whole range of health, medical, environmental concerns and how "science" is easily manipulated or discarded... very often there is plenty of evidence for either side of an issue. If you want to make all of your decisions based off of possibly biased/corrupted/irrelevant statistics or studies, that's your business.
Lest anyone confuse anything, I will state one more time, I DO understand that fundal massage is very necessary sometimes. But I fail to see why it should be done if not needed, and how hard it would really be for an experienced hcp to make that call.
Tha line is propably the single most offensive thing I have read on all my years at mdc and I am not a uc'er. (Ironically enogh, due to my particular circumstances, I chose Ob care in part this time because of my concerns about increased risk in grand multiparity of pph, even though I've never had it and don't expect to. I still expect my ob to treat me as a person with individual needs and not a machine.)
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For me, this thread just reaffirms uc as viable option... and stresses how important it is to know exactly who/what you are getting when choosing a hcp. If I am going to pay hcp for pregnancy/birth, I want them to make decisions about care for ME and I want them to have the expertise to know when something is actually needed or not, (not assume my uterus is going to fail at everything, all the time!)
Kinda reminds me of when you have internet troubles and call for help - talking to a real, attentive person, or getting one of the people reading off the screen - did you do a, please try b... now do c --- when x, y, z is the real issue!!
As far as all the "evidence based" backhanded insults being slung around mdc, here is an interesting article written by Union of Concern Scientists about how a lot of the times your evidence is corrupted - http://www.ucsusa.org/assets/documents/scientific_integrity/how-corporations-corrupt-science.pdf
It has nothing really to do with birth specifically but does address a whole range of health, medical, environmental concerns and how "science" is easily manipulated or discarded... very often there is plenty of evidence for either side of an issue. If you want to make all of your decisions based off of possibly biased/corrupted/irrelevant statistics or studies, that's your business.
Lest anyone confuse anything, I will state one more time, I DO understand that fundal massage is very necessary sometimes. But I fail to see why it should be done if not needed, and how hard it would really be for an experienced hcp to make that call.
This is what I'm talking about. People cling to the "evidence" and "research" that comes out of some of these mega-huge institutions and I swear, most have NO idea how "paid for" and corrupted a lot of this "science" is. Even when it's not for super evil reasons, or because some corporation/industry is making sure trials and research come come out in "easily marketable" ways...the research we are fed often times cannot be taken at face value just because of how sloppy a lot of the science is. It's just sloppy and nonsensical and we must always be on guard against that sort of thing.
This is what I'm talking about. People cling to the "evidence" and "research" that comes out of some of these mega-huge institutions and I swear, most have NO idea how "paid for" and corrupted a lot of this "science" is. Even when it's not for super evil reasons, or because some corporation/industry is making sure trials and research come come out in "easily marketable" ways...the research we are fed often times cannot be taken at face value just because of how sloppy a lot of the science is. It's just sloppy and nonsensical and we must always be on guard against that sort of thing.
I'm interested to know who profits financially from the recommendation that fundal massage and gentle cord traction be a part of every birth. What motivation do the WHO, the ACNM, and the ICM have to recommend fundal massage if it is not worthwhile?
Yes, I believe gentle cord traction to deliver the placenta in a timely fashion should be a part of every birth.
I'm not being snarky here, are you saying that gentle cord traction should be used if the placenta isn't out in X time? Or are you saying that every single birth should follow with gentle cord traction?
The above quote is speaking more about research that is simply sloppily done than research where someone profits based on the results. In the US, guidelines like that protect dr's from liability. The only risk is hurting the mom, which to them is perfectly acceptable. If they just do "everything they can" every time, their butt is covered. Some of us don't want to be treated like that. We'd rather be watched for signs of problems and be treated if they come up. I will not oppose fundal massage if there's signs that things are less than perfect. And I'm sure if my midwife thought something was up, she'd do it above my protests because its better than bleeding out. Also, with the in case of home birth midwives not routinely doing fundal massage, home births are just plain different from hospital births. For example, induced and augmented labors are associated with a higher risk of PPH and these days, though it varies hospital to hospital, almost everyone gets pit during labor even if they weren't induced. (http://www.ncbi.nlm.nih.gov/pubmed/309347 http://www.ncbi.nlm.nih.gov/pubmed/1984230) Obviously, home births are not induced or augmented. This site: http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/postpartum-hemorrhage lists uterine atony the most common cause of PPH. A uterus that is firm and contracting well is not atonic. So in a spontaneous, non augmented birth with a uterus that is firm and contracting well with palpation and normal bleeding.. why on earth would anyone think its a good idea to start "massaging" the uterus "just because"? Observe the flow carefully and check the uterus regularly? YES!
The above quote is speaking more about research that is simply sloppily done than research where someone profits based on the results. In the US, guidelines like that protect dr's from liability. The only risk is hurting the mom, which to them is perfectly acceptable. If they just do "everything they can" every time, their butt is covered. Some of us don't want to be treated like that. We'd rather be watched for signs of problems and be treated if they come up. I will not oppose fundal massage if there's signs that things are less than perfect. And I'm sure if my midwife thought something was up, she'd do it above my protests because its better than bleeding out. Also, with the in case of home birth midwives not routinely doing fundal massage, home births are just plain different from hospital births. For example, induced and augmented labors are associated with a higher risk of PPH and these days, though it varies hospital to hospital, almost everyone gets pit during labor even if they weren't induced. (http://www.ncbi.nlm.nih.gov/pubmed/309347 http://www.ncbi.nlm.nih.gov/pubmed/1984230) Obviously, home births are not induced or augmented. This site: http://pediatrics.med.nyu.edu/conditions-we-treat/conditions/postpartum-hemorrhage lists uterine atony the most common cause of PPH. A uterus that is firm and contracting well is not atonic. So in a spontaneous, non augmented birth with a uterus that is firm and contracting well with palpation and normal bleeding.. why on earth would anyone think its a good idea to start "massaging" the uterus "just because"? Observe the flow carefully and check the uterus regularly? YES!
If you read the first link you posted (the first ncbi link), you will see what I am talking about. The # 1 risk factor for PPH was prolonged third stage. That was the # 1 risk factor. In fact, prolonged third stage increased your risk of PPH 4-5x as much as augmented labor. I have heard many homebirth midwives say, "I have waited longer on placentas than I have on babies!" So who is really putting women at an increased risk for PPH? Hospital based CNMs who augment labor with pitocin? Or homebirth midwives who cause their clients to have prolonged third stage? The evidence shows that it's the homebirth midwives who cause their clients to have prolonged third stage, by an odds ratio of 7.56 to 1.66. This is why active management of the third stage is so very important. Get the placenta out in a timely manner = prevention of PPH.
We all know (or we all should know, if you are delivering babies) that atony causes 70% of PPHs. Per the AAFP, you go Tone, Trauma, Tissue, Thrombin when evaluating PPH. Tone is atony. Just to say, "Oh, it's atony" isn't enough when it comes to prevention. You have to ask yourself, "What CAUSES atony?" in order to determine how you should PREVENT atony. The cause of atony is a tired uterus. So, prolonged first stage, prolonged second stage, prolonged third stage, macrosomia, twins, multipara, augmented labor, etc. Yes, augmented labor is in there, but it's only after other causes such as prolonged third stage (as per the NCBI link you posted). It's clearly not the number one reason for atony.
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