Questions about third stage/delivery of placenta?

[ann_of_loxley]

I have a few questions...

1). What are the resons that a natural delivery of the placenta can not take place?

and

2). If they have to give you that shot (whatever it is lol) - so you do not have the 'natural' delivery of the placenta...Does the cord have to be cut before the shot? (would it pass into the baby?). I would, if all goes to plan - like a natural delivery of the placenta.

I would then only like the cord to be cut after the placenta has been delivered. So just wondering about if I can not, for whatever reason (?), have a natural delivery of the placenta.

Thanks

[nashvillemidwife]

1. Either the placenta is pathologically implanted into the uterine wall (rare) or a lack of uterine contractions to cause separation (most likely). Sometimes the placenta can be detached but not able to pass through the cervix, either because of gravity working against mom's position and/or a cervix that has started to close; this is a dangerous situation as your uterus is filling with blood behind the placenta, which prevents the uterus from contracting to prevent further bleeding. This is why a lot of practitioners practice "controlled cord traction" - this does NOT mean yanking on the placenta while it is still attached, but holding the cord in your hand with enough tension to detect when the placenta has detached so you can gently and safely help the mom expel it.

2. The cord does not have to be cut before the shot and the Pitocin does not reach the baby, though it does cause powerful contractions which can force an unnatural amount of blood into the baby if the cord is still functioning. However, if you are waiting for a natural delivery of the placenta and use Pitocin only after it's determined that it's needed, the vessels of the cord will have begun to close off so that is not as big of a concern as if you have been given the Pitocin immediately after delivery.

Once the cord stops pulsing the baby is done with it, whether it's still attached to the placenta or not.

[kltroy]

The reasons that your plans for a natural delivery of the placenta would be thwarted are mostly danger of hemmorage. You almost certainly will lose more blood without prophylactic pitocin to speed along the uterus contracting. Most of the time it's not much more and it's no big deal. But if you hemmorage you will need an IM injection of pitocin (ie a stick in the leg vs. using an IV or heplock ahead of time) to stop it. Plus if you lose a lot of blood you'll probably feel like crap for the next few weeks from the blood loss (tired, etc from low hematocrit). I have no idea whether they'd want to cut the cord first. I suspect if it were an emergency they would. Lots of times the placenta won't detach UNTIL the cord stops pulsating.

I had a natural delivery of mine with my hospital VBAC and they were happy to do that. In retrospect I'm not sure I would choose it again because I did lose quite a lot of blood (no hemmorage, though) and was not able to take a shower until probably 15 hours after the delivery b/c I felt faint when I stood up. Who knows whether this would have been the case had I had the prophylactic pitocin though? FWIW my baby nursed within 5 mins of being born, which I'm sure helped some...

[mytwogirls]

I am an expert on this one. Neither time my placenta delivered naturally due to placenta accreta. They had to manually extracted it both times, and after the second delivery, I lost so much blood I almost died and I had to have an emergency hysterectomy. It was terrible and the most pain I have ever been in. My OB did everything under the sun to try and save my uterus but I kept bleeding and bleeding and the placenta was not delivering on its own so they had to take drastic measures. It was a living nightmare.

[stacyann21]

I'm not sure but my mw and I definitely clashed over 3rd stage labor management. She insisted I accept an injection of Pitocin after giving birth. I refused. I delivered the placenta just fine. It came out about 20 minutes after the baby and I barely even felt it. I don't understand what the big deal was. Afterwards she started freaking out that I was "clotting" and did a very forceful uterine "massage". She squeezed so much blood out of me I felt very weak and woozy for the next few days. I'm sure it would have been better if she would have kept her hands off me. I am determined to have a completely intervention free 3rd stage w/my next baby. I think it will be a healing experience for me. I really don't believe that pit injection and uterine beating are necessary at all.