"Pulling" on cord to help deliver placenta?

[mama to 2 girls]

I have been trying to get some answers and ask just how dangerous it is to do this......

After dd2 was born she was layed on my stomach and we left the cord to finish pulsing before we cut it, which took about 30 mins...my m/w had me sit up and try pushing out the placenta, I wasn't having to many after pains, so she let me be for another 30 mins. then said she *had* to try pitocin to try and get some contractions going, so she gave me 1 shot and waited about 30 mins. I got VERY MILD contractions as a result, but I still tried pushing and she tried "pulling" on the cord....still nothing. I told her I felt like I needed to pee so she walked with me to the bathroom and placed a chucks pad under me incase it came out while I was trying to pee.....well I couldn't pee....so back to the bed we went and she gave me another shot of pitocin(mind you dd2 was b/f this whole time to try and get contractions going also) again waited about 20 or 30 mins. and we tried again, same as before, me pushing her pulling....still nothing. Only getting very mild contractions....she gave me about another 15 mins. and then reached up inside me to see if she could feel if it was "caught up" on something, she said she felt nothing....Did I mentioned how INCREDIBLY uncomfortable this whole process was.....So she tried a 3rd shot of pitocin, again waited another 15 mins. or so and tried the same process again.....again nothing....so she said she had to call for a transport to the hospital....I freaked out! I DID NOT want to go to the hospital, I had such a horrible experiance there with dd1. So she called and she said we would try one last thing....

As the paramedics arrived about 30 mins. later we shut the door and she had me get into a squatting position and I pushed with all my might while she pulled. FINALLY it came out after about 3 hrs. from the time of birth.

I didn't have any problems with hemmoraging or anything like that, but think I was just fortunate. Did she really do the right thing, or should I consider myself fortunate? She was really hands off thru the whole birthing process (although from the time she arrived it was only an hour long).

She was also a new m/w with only a couple years under her belt. I had been seeing the other m/w who had 8 yrs. experiance but she didn't make it in time because everything happened so fast (from the time I called to birth it was only about 2hrs.)

[mendomidwife]

Managing the third stage is sometimes tricky.....You want the placenta to come out on its own....but you DON'T want the mother to bleed too much while waiting....AND this can happen in two ways....gushes or slow and insidious.
Less than thirty minutes is usual....but more isn't horrible if there is no bleeding - BUT - there can be bleeding in the uterus that is behind the placenta, so you have to watch the uterus' size also...
Some practitioners give Pitocin with placental expulsion to make the uterus cramp down and lessen the chance of hemmorhage, BUT it should be fine on it's own. I think Pitocin, unless absolutely needed should be avoided.
NEVER never never pull on the cord.....it causes problems.
I have NEVER given Pitocin until the placenta was out - EXCEPT in one case - the woman was hemorrhaging and I tried everything including manual removal (which is not as easy as it seems and takes some skill and practice). I got the placenta out, but she basically had two placentas and the smaller one was stuck. The Pitocin kept her from bleeding until we got to the ER.
When you give Pitocin BEFORE the placenta is out it can cause the uterus to cramp down on the placenta and make it hard if not impossible sometimes to get out.
THREE shots of Pitocin is A LOT.....I bet it was very uncomfortable.
One of the causes of PP hemorrhage is pulling on the cord....
Sorry you had to experience this.....I always feel badly when a woman already has her baby and then has to deal with placenta or tearing issues.
Carla

[pamamidwife]

as long as there is no bleeding, I'm fine waiting. Definitely cord traction shouldn't be done if there is a concern that the placenta has not detached. If there isn't bleeding at all, the placenta isn't likely detached. Having mom be alone with baby (nursing, etc), would be best.

I agree with Carla that PPH is often caused by hurrying to get the placenta out.

[ckhagen]

Totally anecdotal, but my brilliant OB (who is notoriously impatient btw) recently used cord traction about 15 minutes after a birth to try and get the placenta out (taking too long for her taste) and ended up yanking the mama's uterus out with it. It took 3 hours of surgery to repair. It sounds like you were in a slightly different situation than that, but regardless I would be wary of taking that route unless absolutely necessary.

[mwherbs]

it sounds like she wasn't pulling too hard- if she were it could have made the situation unstable- and following the cord up is a common trick to try- sometimes the placenta is detached and is corking the os- if you follow the cord up to the os and feel the placenta right there your finger can break the suction/pressure and the placenta will come out-( this is not the same as manual removal) you can give pitocin placenta delivered or not-- were you feeling strong or painful contractions?

[mama to 2 girls]

Originally Posted by mwherbs

it sounds like she wasn't pulling too hard- if she were it could have made the situation unstable- and following the cord up is a common trick to try- sometimes the placenta is detached and is corking the os- if you follow the cord up to the os and feel the placenta right there your finger can break the suction/pressure and the placenta will come out-( this is not the same as manual removal) you can give pitocin placenta delivered or not-- were you feeling strong or painful contractions?

No she wasn't pulling *too* hard but enough to make it uncomfortable and she only pulled while I pushed.

I wasn't having hardly any contractions at all, maybe that's why she was trying to help me out, I don't know. After 3 shots of pitocin and dd2 b/f you'd think I would be having some strong contractions but maybe my body just decided it had enough! HAHA!

She did check for PPH before the paramedics left, so maybe that was a concern.....but I just wonder if what she did was something that is taught but only under *certain* circumstances or if she just did it on her own.

[mwherbs]

the delayed coming placentas that are not detached that I have seen mom isn't having contractions- the uterus may be firm but not contracting and there isn't any pain.
the concern is if there is any blood seen coming out or if the fundus seems to be enlarging then the placenta is detached or atleast partly detached and needs to come out . Something else I have noted in my experience mom feels pain/discomfort probably because blood is irritating to tissues.

[bryonyvaughn]

Originally Posted by ckhagen

Totally anecdotal, but my brilliant OB (who is notoriously impatient btw) recently used cord traction about 15 minutes after a birth to try and get the placenta out (taking too long for her taste) and ended up yanking the mama's uterus out with it. It took 3 hours of surgery to repair. It sounds like you were in a slightly different situation than that, but regardless I would be wary of taking that route unless absolutely necessary.

OMG! I had no idea there were other idiots out there practicing that way. My m*dwife performed cord traction on me (without telling anyone let alone asking permission) and pulled the cord off the placenta. She later claimed I must have been nutritionally deficient to have had such weak tissue.

I guess I'm grateful I didn't eat as healthy a diet as your OB's unfortunate patient.

~BV

[mwherbs]

I have had cords pop off- especially if you wait a while they seem to degrade quickly- so at hour 2 or 3 a small tug to see if it was still tightly in place- pop- but wow the amount of traction used to invert the uterus!!! we usually guard the uterus - for 2 reasons to keep from pulling the cervix out and to tell if it is still firmly attached-- if you are holding your hand just above the pubic bone it blocks the uterus from coming down further- then a small pull and you fell the uterus move and let go and the cord goes back up still attached-- or cervix tightly closed around it--

[bryonyvaughn]

Originally Posted by mwherbs

I have had cords pop off- especially if you wait a while they seem to degrade quickly- so at hour 2 or 3 a small tug to see if it was still tightly in place- pop- but wow the amount of traction used to invert the uterus!!! we usually guard the uterus - for 2 reasons to keep from pulling the cervix out and to tell if it is still firmly attached-- if you are holding your hand just above the pubic bone it blocks the uterus from coming down further- then a small pull and you fell the uterus move and let go and the cord goes back up still attached-- or cervix tightly closed around it--

I'm curious how likely you think a cord would pop off with a gentle tug at 20min pp?

I curious so far as normal birth stuff goes but it wouldn't make a difference regarding my thoughts about that particular MW. She induced & augmented labor, performed cord traction, and attempted manual removal of the placenta w/o my knowledge or permission. I'll never trust HCPs that routinely treat patients/clients that way. I'm justified in saying routinely because it happened in 3 of the 5 births with which I have personal experience she attended

~BV

[pamamidwife]

I had a cord pop off - was just attached to the membranes - with gentle traction at a half hour after the birth. But, I think this is VERY rare - definitely not something I'd say is the fault of nutrition.

A manual removal should be reserved for the times when a client is seriously concerned (even then I'm not sure I'd ever attempt it again), or if there is a partial separation and mom was losing blood. While I'd love to get home after a long birth, I think hanging out as long as it takes if there is no blood loss is sometimes necessary.

[mama to 2 girls]

I can't believe I missed that post about the impatient OB! What as A**!!! Poor mama!

While she didn't try the cord traction until about an hour after dd2 was born, I was still questioning her decision....but from the other posts it seems like she was just doing what she thought was necessary.

[birthgreeter]

I do not give pitocin on a regular basis. (actually almost never) As stated already- the management of the 3rd stage is important to be done careful.
How it is managed, can cause problems.
I do not pull on the cord, and I have never given pit before the placenta is out, (but would consider it if needed for severe bleeding as noted in comment above).
The longest times that I have waited on a placenta was one at 45 minutes, and another one of over 2 hours. Both mothers were fine, no bleeding, I had to take each into a bathroom, have her squat, and we (the birth team) stood between her and the door, as to 'protect her'. The one mother had problems with someone who had shown up after the birth to see the baby, and after getting her into a quiet safe place away from everyone, she delivered the placenta in a squatting position.

[wumanh]

I usually don't do anything except keep an eye on the size of the uterus or how the mom is doing (alert, with it, nursing baby, etc). The longest I've waited is 4 hours. The mom just wasn't ready to let go. She finally squatted and pushed out the placenta with about 2 tbl of blood - I am not kidding! She had bled with her first baby and this time she was religious with herbal infusions and visualization. If mom is fine, I wait. Also do not disturb the immediate pp time with mom and baby. Nature sets up a finely choreographed dance between them and all those hormones that we do not want to interfere with.

[SublimeBirthGirl]

I'd be fine waiting (for me, I mean; I'm not a midwife) as long as I felt okay, not bleeding, etc. I wouldn't want Pit and DEFINITELY no cord traction.

[mwherbs]

Originally Posted by bryonyvaughn

I'm curious how likely you think a cord would pop off with a gentle tug at 20min pp?

I curious so far as normal birth stuff goes but it wouldn't make a difference regarding my thoughts about that particular MW. She induced & augmented labor, performed cord traction, and attempted manual removal of the placenta w/o my knowledge or permission. I'll never trust HCPs that routinely treat patients/clients that way. I'm justified in saying routinely because it happened in 3 of the 5 births with which I have personal experience she attended

~BV

sounds like you have several different issues here- I don't know I wouldn't blame nutrition on why a cord pops off- I take it to be a belief of hers, it is not something that as any evidence for it, and just like when I say I think it degrades quickly once out I don't think that there is any evidence for that either but after a birth and we are handling a placenta to show the family, make a print or just check for completeness- the first thing that really looses tinsel strength is the bag- many just shred or tear- and some placentas the divisions become deeper and chunks may pop off -- since I have had some delayed cords pop off and I know that what I do is very gentle traction and not some sort of sheering traction then I just think it is like the other parts that fall apart and I know of babies who's cords have broken at birth- so it could be that at 20 minutes it just could pop off or it could be that she was pulling hard-- I have seen a range--
I don't have to read the historical record I have had a client who always has 24 hr placentas- and I have mentioned this before on MDC - usually gets a bad reaction from some medical providers- I was sure that it wasn't just sitting in the vagina- providers before me and after have had to share the experience-- because all of her placentas have taken 24 hrs to deliver- her uterus stays firm but not extremely so-she does not have contractions- until the placenta detaches and is ready to come- she looses very little blood- she doesn't have a uterine scar I have waited many hours for placentas but I have done a little checking too once in a while a placenta will deliver into the vagina and then just be sitting there- blood will be pooling around it and we may have a very occult hemorrhage- if you guard the uterus and when you give a slight tug and it doesn't rebound -- then you have mom give a push and relax plop it will come out-- we also do a bit of a twist too so that the membranes don't shred and get left in-- many times a cough will deliver a placenta--