I'm curious if you've always gotten the baby to the breast immediately? I know that breastfeeding can have the same effect as pit...BUT, I've known a few all natural moms who've had pit for 3rd stage and been totally satisified. It seems to cause shaking, but that is a continual drip...just a quick shot might not do that.
Need opinions on 3rd stage management
I'm expecting my 4th child in May. I have had pph with each of my previous births (650ml, 550ml, and 600ml). It was stopped with pitocin, methergine, and anal cytotech
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. We have always waited until the bleeding started before taking action (the bleeding starts when the placenta detaches). My midwife and doula are both of the opinion that because I have a history of pph, that I should have a shot of pitocin as soon as the shoulders deliver. I have read the studies that compare active management to physiological management and it does appear that there is evidence that active management might be my best option (we would still delay the cord clamping). I am having a hard time wrapping my mind around this, as I am a natural minded person and it seems to me that my body should be able to do it's job without drugs. Just wondering other's opinions or any suggestions for other options. Thanks.
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Not a midwife yet but I have to agree with this. Especially since it's happened in all three of your births. Prophylactic pit in combination with a babe quickly on the breast seems like your best bet.
Originally Posted by jengacnm  Sure, your body SHOULD be able to do its thing without drugs, but it hasn't-three times. To ignore a consistent history based on what you want rather than what was and is very likely to be again seems a bit like magical thinking. Pitocin is such a minor intervention and avoids such a serious problem that it seems like much better than a good idea. |
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Some questions--
were these hospital births? Were they induced? (I have seen more pph with inductions than with homebirths, because the hbs weren't tinkered with), were the labors long?(Longer labors(24 hr of active labor or more sometimes contributes to pph)
were you allowed to eat and drink and move freely during labor? (Hydration and food can help a mom deal well with blood loss, even if she loses more than normal).Having a full bladder can help contribute to pph by keeping the uterus boggy.
Were there clots afterwards? (Clots inside, can prevent the uterus from clamping down fully, and can cause pph).
Were any of the births posterior? (I think(my unofficial opinion here) that it sometimes takes longer for a posterior baby to turn around, and might contribute to pph)
How was your diet during pg? If there was a problem with anemia, or absorption of iron, might that have contributed to the pph.
These were just thoughts rambling thru my pea-brain...I agree with previous posters that suggested rrl tea, nettles, and other herbal preparations. Also, did you have a chance to swallow a piece of placenta?(bout fingernail size?) I have seen it stop a pph in its tracks. Shepherds purse and/or Lady's mantle tincture does that too...
After a few minutes of searching in Myles Midwifery, I came up with some other possible causes:
Incomplete placental separation
Precipitate labor(I forgot about this one!)- labor lasting less than 1 hr start to finish)
Mismanagement of 3rd stage of labor(fundus fiddling)
Fibroids
and Ketosis(hadn't thought of this either).
So there are a lot of reasons why you might have bled some. FWIW, I looked up the definition of pph, and it is more than 500ml estimated blood loss. But yours doesn't sound like it was way off(like 1500 ml or anything) , so even tho it was 500,(and some people have trouble determining what that looks like) still good to have precautions in place, but to me almost sounds like a judgement call.
Originally Posted by mamaw/two I'm expecting my 4th child in May. I have had pph with each of my previous births (650ml, 550ml, and 600ml). It was stopped with pitocin, methergine, and anal cytotech
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were these hospital births? Were they induced? (I have seen more pph with inductions than with homebirths, because the hbs weren't tinkered with), were the labors long?(Longer labors(24 hr of active labor or more sometimes contributes to pph)
were you allowed to eat and drink and move freely during labor? (Hydration and food can help a mom deal well with blood loss, even if she loses more than normal).Having a full bladder can help contribute to pph by keeping the uterus boggy.
Were there clots afterwards? (Clots inside, can prevent the uterus from clamping down fully, and can cause pph).
Were any of the births posterior? (I think(my unofficial opinion here) that it sometimes takes longer for a posterior baby to turn around, and might contribute to pph)
How was your diet during pg? If there was a problem with anemia, or absorption of iron, might that have contributed to the pph.
These were just thoughts rambling thru my pea-brain...I agree with previous posters that suggested rrl tea, nettles, and other herbal preparations. Also, did you have a chance to swallow a piece of placenta?(bout fingernail size?) I have seen it stop a pph in its tracks. Shepherds purse and/or Lady's mantle tincture does that too...
After a few minutes of searching in Myles Midwifery, I came up with some other possible causes:
Incomplete placental separation
Precipitate labor(I forgot about this one!)- labor lasting less than 1 hr start to finish)
Mismanagement of 3rd stage of labor(fundus fiddling)
Fibroids
and Ketosis(hadn't thought of this either).
So there are a lot of reasons why you might have bled some. FWIW, I looked up the definition of pph, and it is more than 500ml estimated blood loss. But yours doesn't sound like it was way off(like 1500 ml or anything) , so even tho it was 500,(and some people have trouble determining what that looks like) still good to have precautions in place, but to me almost sounds like a judgement call.
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Thanks for the thoughtful answer. I did have hosp births, the first was a pit induced 30hr labor. The next two were not induced, but were long (20hrs and 35hrs). I was allowed to eat, drink, and move about freely in the second two labors. I did keep my bladder empty (dh still laughs about me running into the bathroom every 5 mins
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). In my last pregnancy, I drank rrl and nettle tea like it was going out of style! This time I'm taking nettles, alfalfa, and rrl tincture, I also just added Floradix to daily regiment. I am also planning on keeping the placenta to consume, but don't know how I would manage to let them give me a piece to eat! I didn't really think that my blood loss amounts were that much, but my midwife says that it was?
Originally Posted by cathicog Some questions-- were these hospital births? Were they induced? (I have seen more pph with inductions than with homebirths, because the hbs weren't tinkered with), were the labors long?(Longer labors(24 hr of active labor or more sometimes contributes to pph) were you allowed to eat and drink and move freely during labor? (Hydration and food can help a mom deal well with blood loss, even if she loses more than normal).Having a full bladder can help contribute to pph by keeping the uterus boggy. Were there clots afterwards? (Clots inside, can prevent the uterus from clamping down fully, and can cause pph). Were any of the births posterior? (I think(my unofficial opinion here) that it sometimes takes longer for a posterior baby to turn around, and might contribute to pph) How was your diet during pg? If there was a problem with anemia, or absorption of iron, might that have contributed to the pph. These were just thoughts rambling thru my pea-brain...I agree with previous posters that suggested rrl tea, nettles, and other herbal preparations. Also, did you have a chance to swallow a piece of placenta?(bout fingernail size?) I have seen it stop a pph in its tracks. Shepherds purse and/or Lady's mantle tincture does that too... After a few minutes of searching in Myles Midwifery, I came up with some other possible causes: Incomplete placental separation Precipitate labor(I forgot about this one!)- labor lasting less than 1 hr start to finish) Mismanagement of 3rd stage of labor(fundus fiddling) Fibroids and Ketosis(hadn't thought of this either). So there are a lot of reasons why you might have bled some. FWIW, I looked up the definition of pph, and it is more than 500ml estimated blood loss. But yours doesn't sound like it was way off(like 1500 ml or anything) , so even tho it was 500,(and some people have trouble determining what that looks like) still good to have precautions in place, but to me almost sounds like a judgement call. |
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Well, my first one I was very worn out and lightheaded (650ml loss). It took about 3 monthes to get my energy back. The second one, I felt completely fine (550ml loss). The third was like the first (600ml loss).
Originally Posted by Pirogi How did you feel after the blood loss at your births, if you don't mind my asking? Keep in mind that 500 mL is the arbitrary definition of hemorrhage, and it is the same amount taken when a person gives blood. Did you feel light-headed? Anxious or confused? Did you have blue or gray lips/face/fingertips? Do you remember if your blood pressure dropped or your pulse increased? Blood loss is nothing to kid around about, but I think that some women may be able to withstand more than 500 mL without serious adverse effects. And if you are going to be in a hospital with this birth, I think it is perfectly reasonable to wait again until signs of PPH appear. JMHO. |
Well, my first one I was very worn out and lightheaded (650ml loss). It took about 3 monthes to get my energy back. The second one, I felt completely fine (550ml loss). The third was like the first (600ml loss).
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Very good point. Thank You.
Originally Posted by pamamidwife The less interference immediately postpartum the better - and the IM Pitocin might actually facilitate a less interfered-with experience than not. |
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Thanks for the info on the UK protocol for active management, this is most likely what I'm going to write into my birth plan
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Originally Posted by Apricot I recommend a particular UK protocol for active management that is clinically tested to be effective and reduce blood loss. A pitocin injection is given after the baby is born. The cord is clamped as desired, before or after the placenta is born. The placenta is awaited with typical expectant managment. Some midwives think that active management has to be a shot as the shoulders are born, immediate cord clamping, and cord traction to deliver the placenta. But it can be a nice homebirth midwifery-style third stage with the addition of a shot in the first 2-3 minutes after the birth. The placenta (statistically speaking) will come faster, though. Worldwide, a blood loss of more than 500 ml happens to 1 in 7-8 women. It's the most common complication. If you happen to be an always-bleeder, at least you're in good company. |
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