retained placenta and manual removal

[snugglebug14]

I have a doula client who recently gave birth (I missed her birth because I had the stomach flu but my backup was there) she was 42 weeks with no signs of labor starting soon despite stripping membranes, acupuncture and homeopathy. She was induced with pitocin, taken off pitocin 2 hours later and the baby was born 4 hours after that. No pain meds
Postpartum she had minor bleeding but after 4 minutes there were no signs of placental separation. Apparently the OB did NOTHING to encourage the placenta (no nipple stim, didnt have her pee, didn't have her change positions) and then said, "well you better call the anethesiologist because her uterus is closing down and that placenta is going to come out so I'm going to have to do something". I have SOOO Many issues with the management of this third stage. My big question is what was he referring to when he said her uterus was closing down? this mom is really distraught and found the whole experience unbelievably traumatic and I don't blame her. My heart really goes out to her and I am trying to understand what happened.

[nashvillemidwife]

Are you sure he said the uterus was closing down, and not that the cervix was closing up? Actually, I suppose those mean the same thing so that's probably what he was referring to.

[mendomidwife]

Sounds like he had a golf game to go to.....

Carla

[honeybunch2k8]

Ooops I'm sorry I'm in the wrong forum!

[cathicog]

Originally Posted by snugglebug14

Postpartum she had minor bleeding but after 4 minutes there were no signs of placental separation. Apparently the OB did NOTHING to encourage the placenta (no nipple stim, didnt have her pee, didn't have her change positions) and then said, "well you better call the anethesiologist because her uterus is closing down and that placenta is going to come out so I'm going to have to do something". I have SOOO Many issues with the management of this third stage. My big question is what was he referring to when he said her uterus was closing down? this mom is really distraught and found the whole experience unbelievably traumatic and I don't blame her. My heart really goes out to her and I am trying to understand what happened.

He probably meant the cervix was closing up, so big deal. it is still soft enough, if he did controlled cord traction, to get it out, easily. He was probably in a big hurry(I like the pp's explanation!) Most placentas are out on thier own, within 30 min, but can take up to two hours with no problems. But the sooner it comes out(on its own, preferably) the better. Manual removal? what was he after? I know one isn't supposed to second guess another birth attendant, but I have had this very thing happen to me personally (cervix closing up after birth) and just a gentle cord traction is all it took to get it out.

[snugglebug14]

wow I just realized I had a HUGE typo....it was 45 minutes not 4......so it had been in there beyond the edges of hospital comfort/normal. but still, i feel like he did nothing to help a long and then just declared it wasnt coming.

can a cervix close to the point that it wont allow the placenta out? would the weight of the placenta "re-dilate" it once its detached and trying to fall through?