From what I understand it is safe to leave the placenta attached when there is little or no bleeding
and women have left their placentas inside for up to 24 hours in some cases. Try THAT (allowing 24 hours for a placenta to deliver) at a hospital!
or even with a very medicalized midwife, they wouldn't allow it. These are the questions you need to ask when interviewing midwives...how they handle 3rd stage difficulties and ask them to give examples.
This is what I don't understand, I don't know if anyone telling these stories about placenta mismanagement really can tell me what kind of hemmoraging was already happening causing their caregiver to take action?
Messing with the placenta with no bleeding or little bleeding would be bad management. Judging amount of bleeding is complicated stuff, not for novices....so I ask you who would I trust, me or my attendant on what constituted an uncomfortable amount of bleeding? Trust your attendant...it's practically a no brainer.Once the bleeding gets past a certain point,
the procedure for DEMS (direct entry homebirth midwives) is to ask the mom to stop bleeding. Then, depending on factors (placenta low or high, cord snapped or intact) If high and cord intact, you would have the mom hold her breath and push (try this at home, it is a much softer push than when you aren't holding your breath and it makes the push come from the top where the placenta would be located). While the mom holds her breath while she pushes, the midwife patiently and extremely gently pulls on the cord. At the same time, someone gently massages the mom's abdomen being sure not to push down on the fundus (the fundus is the top area, the top of the uterus, or baby pooch).
If the mom has already lost a pint, then the caregiver gets more agressive by wobbling the cord back and forth, still gently, visualizing it anchored from the top and peeling downward. Massaging from pubis to umbilicus. Mom holding breath while gently pushing. Using gentle traction on the cord.
You are supposed to be basically watching the mom hemmorage while patiently, gently and with perserverance trying to gently coax this placenta away. If this doesn't work, you don't pull harder,
you try a different position like squatting.
I think the reason they peel low lying placentas with troublesome bleeding because maybe you can't get the same traction with the cord or benefit from holding breath and pushing (you can feel that holding breath and pushing would do nothing for low lying placentas if you hold your breath and push). You do not have the mom push in this case, cord traction is enough with peeling. You would only have the mom push while peeling placenta if the cord was snapped.
It is a tricky thing really to blame the midwife or doctor for hemmorrage. I'm thinking that no one is going to lose their licence over this. Without going into prenatal care, diet, exaustion, trauma in pregnancy, a lot of factors play into preventing hemmorrage that kind of puts the midwife whose peeling the placenta off some poorly nourished, exausted hemorraging mom at kind of a really unfair disadvantage when the time comes to judge whether or not she peeled it off slowly enough. Maybe if the mom had better nutrition, had less stress or exaustion she wouldn't bleed out when trying to get the placenta out...these are just my thoughts...really I do not know. I am not a midwife at all and have not a lot of experiences with these things. I'm just giving some feedback like was asked. I know the birth where I hemmorraged was my most stress filled least nourished pregnancy. I really think the stress in pregancy played a factor in my placental abnormality and hemmorage, and I would bet that it plays a factor in some other hemmorrages too. Since no one tugged or pulled at my placenta and I didn't have a midwife, I've had to look for answers for my hemmorage beyond just "the midwife or doctor almost killed me". I did however write a poem called "The placenta in my freezer almost killed me",though. But I don't hear anyone else here besides me getting really pissed off at their placentas. Mine was a real bitch, I tell ya. I hacked her up with a big knife and planted her under a thorny bush.