Can pulling the PLACENTA/CORD out by force really cause too much bleeding? - Mothering Forums

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#1 of 21 Old 06-07-2008, 02:02 PM - Thread Starter
 
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My midwife didn't believe me the other day when I told her that I lost a quart of blood due to uterine atony. (she believed me about the quart- that's just a fact and why I became anemic but she didn't believe it was just from the uterus exhaustion.)

She suggested that the midwife who attended my hospital birth might have pulled out the placenta too quickly and that that is what would cause most of that bleeding...

There's really no way to know for sure if she did...It was a year and a half ago so it's not like I can call her up and ask...

But do you any of you know about too much bleeding as a result of pulling the cord/placenta out before it would naturally come out on its own?

-Caitrin

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#2 of 21 Old 06-07-2008, 02:06 PM
 
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Something like this happened to me.
I had a quarter sized piece of retained placenta that caused severe hemmorhaging. I really think this was caused by the mw "encouraging" the placenta to come out too soon, by some cord traction and fundal pressure.

In fact, the whole thing was so traumatic for me that I am spending hours and hours this pg researching and thinking about how to avoid this happening again. Again using mws in the hospital.

I suggest doing some research online about natural third stage of labor.

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#3 of 21 Old 06-07-2008, 02:09 PM - Thread Starter
 
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Originally Posted by Lorette View Post
In fact, the whole thing was so traumatic for me
Mine was traumatic too

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#4 of 21 Old 06-07-2008, 02:10 PM - Thread Starter
 
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Originally Posted by Lorette View Post
Something like this happened to me.
I had a quarter sized piece of retained placenta that caused severe hemmorhaging. I really think this was caused by the mw "encouraging" the placenta to come out too soon, by some cord traction and fundal pressure.
That's really interesting. It makes sense though that a piece would be left if pulled too soon. I'm going to do more research on this too!

-Caitrin

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#5 of 21 Old 06-07-2008, 02:19 PM
 
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Definitely. Cord traction with an attached placenta is a big fat no-no.

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#6 of 21 Old 06-07-2008, 02:28 PM
 
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yeah, what seems likely is that the bleeding was so severe because your uterus was atonic - after cord traction on the still-attached placenta made the bleeding start, the uterus was unable to clamp down on the wound and make it stop. so, your mw is kind of half-right. atonia alone doesn't cause bleeding, it just creates a condition where bleeding is difficult to stop if it starts.

but, also, just in general, it's a very bad idea to "pull" on a cord when the placenta is still attached. that's what causes the bleeding in the first place. even if a uterus is NOT hypotonic/atonic, cord traction on an attached placenta can still cause major bleeding, major problems.

i would argue that any birth professional worth their salt should know that cord traction is the inappropriate measure to take in the vast majority of cases. in short, do NOT let someone do this to you.

i'm so sorry you had a bad birth experience. i hope you find peace and that this next birth will be much better.
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#7 of 21 Old 06-07-2008, 02:31 PM
 
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A cord should never be pulled out. Or tuged on. Or messed with at all really. Your body will naturally birth in on it's own. If it is tugged or pulled it can tear, leave a chunk behind, or actually tear your uterine lining and cause even more problems. Ick, I hate that docs, and especially midwives do this still. They should know better.

Sorry, you whent threw this.

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#8 of 21 Old 06-07-2008, 03:51 PM
 
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nak...
Yes, pulling on the cord can lead to heavy blood loss.

during my first birth the doctor grabbed ahold of my cord and pulled with her full body weight. i lost 100cc of blood

at my hb nobody touched the cord and i only lost 250 cc of blood

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#9 of 21 Old 06-07-2008, 04:28 PM - Thread Starter
 
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Originally Posted by MammaB21 View Post
A cord should never be pulled out. Or tuged on. Or messed with at all really. Your body will naturally birth in on it's own. If it is tugged or pulled it can tear, leave a chunk behind, or actually tear your uterine lining and cause even more problems. Ick, I hate that docs, and especially midwives do this still. They should know better.

Sorry, you whent threw this.
Ugh! It can tear the uterine lining? That didn't happen to me, but the fact that that CAN happen with pulling the cord is just scary.

That bad huh? Wow, I really hope she never pulled out the cord but it's sounding more like she did...

How awful...

-Caitrin

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#10 of 21 Old 06-07-2008, 04:38 PM - Thread Starter
 
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I have 2 questions that hopefully someone can answer:

1. Can uterine atony from pitocin alone cause a woman to become a quart low on blood? (my current midwife does NOT think that's possible)

and

2. If the reasons for loosing a whole quart of blood also included pulling the placenta/cord out, why when I asked her after my birth what caused the blood loss did she only give the reason of uterine atony? (is pulling the placenta/cord out by force something she could get in trouble for and therefor, wouldn't admit it or...?)

Just a wee bit confused.

-Caitrin

P.S.- I need to know this information because my current midwife is really trying to better understand my last birth so she can do all she can to avoid what happened last time. I'll be birthing at a birth center this time instead of a hospital and she wants to create a better environment for me.

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#11 of 21 Old 06-07-2008, 05:58 PM
 
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I'll try.

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Originally Posted by Celticqueen View Post
I have 2 questions that hopefully someone can answer:

1. Can uterine atony from pitocin alone cause a woman to become a quart low on blood? (my current midwife does NOT think that's possible)
No, in short. Uterine atony simply describes a condition in which the muscle tissue of the uterus is exhausted and can no longer contract. If this condition is accompanied by intrauterine bleeding, the atony makes things worse because the body's natural response to stopping normal postpartum blood loss is to tell the uterus to contract, to clamp down on the bleed site.

If your uterus is atonic from hours of counterproductive Pitocin-induced contractions, it goes floppy and can't contract in the third stage of labor to push out the placenta and stop the normal postpartum bleeding. So if you add to the problem by pulling on the cord to "help" the placenta out, you're causing trauma to the part of the uterus where the placenta is attached. This will cause massive bleeding, and if you're in uterine atonia, your body can't do anything naturally to stop it.

Simply put, you already have to be bleeding heavily from somewhere in order for you to lose a quart of blood. So, why were you bleeding so heavily? It is normal for a woman who has just given birth to bleed for several days or even weeks postpartum. Your bleeding was over the top, suggesting some sort of internal injury. How did THAT happen?

Well, here's what looks like the likely scenario:

Quote:
2. If the reasons for loosing a whole quart of blood also included pulling the placenta/cord out, why when I asked her after my birth what caused the blood loss did she only give the reason of uterine atony? (is pulling the placenta/cord out by force something she could get in trouble for and therefor, wouldn't admit it or...?)
She didn't exactly lie to you, she just committed what I see as a lie of omission. Uterine atonia does not CAUSE bleeding (see above) - it renders the uterus unable to stop profuse bleeding if it does occur. Yes, she could get in "trouble" for using cord traction when the placenta was still attached, and medical professionals are well trained in the art of diversion. She didn't lie to you, but she didn't tell you the whole truth, because, yes, she was probably concerned that she would face professional repercussions for pulling on the cord.

Good luck with your next one.
I'm glad to hear your new MW wants to be involved and help get some understanding about how your last birth went. IT might be valuable to get a copy of your hospital records and let your new MW take a look at them.

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#12 of 21 Old 06-07-2008, 06:23 PM - Thread Starter
 
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I'll try.



No, in short. Uterine atony simply describes a condition in which the muscle tissue of the uterus is exhausted and can no longer contract. If this condition is accompanied by intrauterine bleeding, the atony makes things worse because the body's natural response to stopping normal postpartum blood loss is to tell the uterus to contract, to clamp down on the bleed site.

If your uterus is atonic from hours of counterproductive Pitocin-induced contractions, it goes floppy and can't contract in the third stage of labor to push out the placenta and stop the normal postpartum bleeding. So if you add to the problem by pulling on the cord to "help" the placenta out, you're causing trauma to the part of the uterus where the placenta is attached. This will cause massive bleeding, and if you're in uterine atonia, your body can't do anything naturally to stop it.

Simply put, you already have to be bleeding heavily from somewhere in order for you to lose a quart of blood. So, why were you bleeding so heavily? It is normal for a woman who has just given birth to bleed for several days or even weeks postpartum. Your bleeding was over the top, suggesting some sort of internal injury. How did THAT happen?

Well, here's what looks like the likely scenario:



She didn't exactly lie to you, she just committed what I see as a lie of omission. Uterine atonia does not CAUSE bleeding (see above) - it renders the uterus unable to stop profuse bleeding if it does occur. Yes, she could get in "trouble" for using cord traction when the placenta was still attached, and medical professionals are well trained in the art of diversion. She didn't lie to you, but she didn't tell you the whole truth, because, yes, she was probably concerned that she would face professional repercussions for pulling on the cord.

Good luck with your next one.
I'm glad to hear your new MW wants to be involved and help get some understanding about how your last birth went. IT might be valuable to get a copy of your hospital records and let your new MW take a look at them.

Wow...and wow. Thank you so much for taking the time to write all this info. It's fascinating- I had no idea.

I still don't understand something- she told me that uterine atony *does* cause a lot of blood loss. Would that be malpractice if that's a lie?

But it sounds like according to your post, she *did* leave out pertinent information. Sigh. It's frustrating if she didn't give me the whole scoop.

My midwife has sent me on a mission to try to find out by the people who witnessed the birth- my mom, my MIL and my husband to ask if they remember her doing that.

Her whole point is that if my past midwife *did* indeed cause the majority of the quart loss of bleeding, the chances of me bleeding that much this time around will be significantly lower since the midwives at the birth center do NOT force anything out.

Thanks again for that valuable infor! And for the hug

-Caitrin

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#13 of 21 Old 06-07-2008, 11:41 PM
 
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Yes, this definitely happens. It kind of scares me that a midwife or any caregiver would doubt that.

Not only can it cause blood loss, there have been accounts albeit uncommon of caregivers actually pulling out or inverting the uterus from yanking on the cord.
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#14 of 21 Old 06-08-2008, 12:25 AM
 
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Oh yes, pulling on the cord and forcing the placenta out definately causes blood loss. It happened to me. The doctor said I "almost hemmoraged" but when I look back and remember my husband telling everyone to be careful of the LARGE puddle of blood on the floor I wonder if it was really 'almost' since 2 cups of blood loss is hemmoraging. I don't know anything about uternine atony though.

Your current midwife sounds great! Wanting to make sure that this birth is better, talking to you about the issues, that's wonderful. I hope this birth is a million times better for you.

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#15 of 21 Old 06-08-2008, 04:14 AM - Thread Starter
 
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Your current midwife sounds great! Wanting to make sure that this birth is better, talking to you about the issues, that's wonderful. I hope this birth is a million times better for you.
Heheh...I think it had something to do with the fact that I started sobbing when she asked about the birth

After that she was a bit determined to make things better for me this time

Thanks for your encouragement! I too hope this is better...Good grief, I need a good birth dang it.

-Caitrin

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#16 of 21 Old 06-08-2008, 05:02 AM
 
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I don't mean to divert the thread, but I'm a little confused now. I had a good birth experience (1st babe) at a birthcenter with CPMs, and after I delivered my boy (about 5 hours total, 40 minutes pushing in the tub), I didn't have any contractions (that I was aware of) and I had some bleeding from a couple of minor injuries, so my MW was wanting to get me cleaned up a bit so she could tell what was going on/do stitches, whatever. So a good bit after my babe was with us, cord was done pulsing, he was at my breast, I don't really have any sense of timing, she gave my cord a gentle tug and pulled out my placenta. Was that a bad idea? I have read some horror stories about violent traction and that is definitely not what was going on, but I wonder if I should know about anything if we have another baby? I didn't have any issues with unusual lochia, I actually stopped bleeding after about 2 weeks and it was fairly light the whole time.
Celticqueen, I hope you have a beautiful, empowering birth!
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#17 of 21 Old 06-08-2008, 06:37 AM
 
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My son literally shot out and onto the (padded!!) floor, his leg was tangled in the cord and pulling on it and I bled very heavily, over 2 litres! Other than the effects of the blood loss it was a great birth
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#18 of 21 Old 06-08-2008, 01:17 PM
 
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... So a good bit after my babe was with us, cord was done pulsing, he was at my breast, I don't really have any sense of timing, she gave my cord a gentle tug and pulled out my placenta. Was that a bad idea?
a "gentle tug" after the cord has stopped pulsing and babe is at the breast is a different scenario, for at least two reasons:

-cord not pulsing = blood volume flowing through cord (and consequently through placenta) not as high
-babe at breast = releases oxytocin that helps the uterus get through the third stage

the scenario you describe seems to suggest that your mw took her time, let the third stage happen naturally, and didn't just "yank".

all these questions remind me to repeat what another poster said upthread - we would all benefit from learning a little more about the third stage of labor.
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#19 of 21 Old 06-08-2008, 01:33 PM
 
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fwiw, you CAN hemorrhage like that IF you are bleeding already.

In my recent birth both I and my uterus were completely exhausted at the end and my placenta started to detach immediately. I started bleeding profusely and when the doctor tried to use traction to help the placenta out (I truly could NOT push yet) he realized the cord was velamentous and could NOT use it to pull. So I am very confident that had nothing to do with the bleeding. He eventually had to go in and help one area detach (I'd had 2 D&C in the past year so that may have caused it to stick) while I pushed with all my (little) might and a nurse massaged. I lost over a liter in less than 5 minutes thanks to that.

I'm sure my situation is more rare, though, as I have had numerous miscarriages (19), 2 D&C and was physically in terrible shape due to hyperemesis the whole pregnancy. Most women's bodies will be in better shape come 3rd stage of labor.

My first D&C last year was due to atony as well, during a 12 week miscarriage where the placenta failed to fully detach and I hemorrhaged as well.

So your midwife who said atony causes that kind of bleeding isn't inaccurate, it just depends on what your placenta was doing and not doing.
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#20 of 21 Old 06-08-2008, 01:37 PM
 
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So your midwife who said atony causes that kind of bleeding isn't inaccurate, it just depends on what your placenta was doing and not doing.

yeah, that's what i was trying to say. atony just makes it likely that you'll bleed badly if you're already bleeding because of something going on with your placenta.
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#21 of 21 Old 06-08-2008, 05:18 PM - Thread Starter
 
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This is great info, everyone. I really appreciate it.

I just asked my husband if he remembers the midwife pulling on the cord and he said he does have memories of her doing that, but didn't know if it was "forceful" because well, he was a little distracted by a person coming out of my vagina

I'm going to ask my MIL though...

-Caitrin

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