Manual placental extraction

[lovingmommyhood]

X-posted in May DDC

Alright, I know some of you sort of know my "story" but I will brief you.

DS1 I was induced at 38 weeks because of a severely deteriorated placenta combined with high blood pressure and swelling.

I was induced with cervadil, labored for 7 hours and he was born vaginally. Everything went completely fine and I only pushed for approx. 10 minutes. Well, after he was born and sitting on my chest (so I'm talking like 2 minutes after) I saw my OB pull on my cord and I saw what looked like a stump from the cord... meaning it had ripped from my placenta. Well suddenly he is elbow deep into my birth canal and is ripping chunks of my placenta out. I start yelling and crying... it. was. awful.

Fast forward 2 years...

DS2 went into labor naturally on his due date. Labored for 4 hours. He was born vaginally with no complications. Pushed twice. I had an epidural as soon as I got to the hospital because I was terrified of having another manual extraction. I really attribute that traumatic experience (along with other things like DS1's & my struggles to nurse for two months...though we finally got it... ya!) to my difficulty bonding with DS1 and I didn't want that to happen again.

Well, after DS2 came flying out (again immediately) the OB (one I had never had before) asked for a "banjo kit" and removed my placenta that way. Thank God I had my epidural was all I was thinking. The OB told me "Well you have awful placentas but they make healthy babies".

Now... when I look back on it I'm just so confused! I think that in the first birth the OB just pulled on it stupidly when he shouldn't have. Especially knowing that my placenta was more deteriorated than normal it would only make sense that it would be more fragile.

Than in the second case... why on earth did she just go in after it after 2 minutes? Just because it happened last time? I really wish I had my medical records, but it's like $2 per page and besides that I'm sort of too lazy to bother.

Well anyway, this time I have a new CNM and he seemed to be as confused as I was especially about birth number two. He said we will wait barring any serious problem like severe bleeding. I'm going to go ahead and skip the epidural but I'm really afraid that it will happen again anyway and I just don't know if I can take it!

Also, I'm afraid of leaving the placenta in too long and then needing a manual extraction after it's already tightened up some. Is that not something to worry about??

Anyway, thanks for letting me vent/worry out loud. I'm hoping everything goes smoothly & I am going to do whatever I can to make sure I have a strong placenta... having this subchorionic hemmorhage now just makes me crabby. I feel like it's always something!!

[ZoeyZoo]

I'm not a birth professional... but manual extraction is not the evidence based way to manage the 3rd stage (placenta). The evidence based way is to let the body deliver the placenta naturally. Unfortunately many care providers (esp hospital car providers like OB) try to speed up the process because they usually have to wait around until the placenta is delivered. You typically don't find this as often in MW care (especially home and birth center births) because force removal can lead to hemmerage. The only time it should be tempered with is in the case of a retained placenta but 2 minutes is not enough time to say that it isn't coming out on its own.

I don't know the climate and routine of things where you live but you can request no interference with the delivery of the placenta. That is actually something I write in my birth plan.

[midwifemom3]

There is no reason to manually remove a placenta unless it is not separating and has been 30 minutes, but this can be standard practice for docs. Go to a midwife, they will leave it alone. Your uterus wont tighten up with it in there.

[Vancouver Mommy]

I'm not a birth professional either but I am interested in the responses as I had a manual extraction as well. After waiting an appropriate amt. of time the mw tried to guide it out but there was a velementous insertion and one vessel became detached and started to bleed. I was told that my cervix had closed and was transferred to hospital for manual removal. Thankfully I did not find the whole experience as traumatic as the pp, although it was certainly not what I'd planned! I lost a lot of blood (2 litres) and had a transfusion a couple of days later.