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Question about how this was handled, just because it made me uncomfortable

1108 Views 11 Replies 9 Participants Last post by  Charmie981
I was lucky to be with my sister, supporting her (emotionally as well as physically holding her) when she gave birth to her first child. She was at the same freestanding birth center where I gave birth to my last child. The birth was just awesome. However, I was very uncomfortable with what happened surrounding the delivery of her placenta. First, the midwives began pulling on the cord within 20 minutes of the birth (probably not so much pulling as just checking to see if it was detached?), it wasn't ready and my sister was feeling no contractions, and every couple of minutes checked again. The last time the midwife pulled she said "I felt something give but I don't think it was the placenta." The cord had become detached from the placenta-it seemed as though she pulled it right out, though I don't know if that's what happened or if that's even possible. Shortly after that, there was some urgency-a shot of pitocin for my sister, one of the midwives reaching into my sister's uterus and pulling out clots, talk of retained placenta, and a call for an ambulance "just in case", manual extraction of the placenta. Turns out there was no need to send my sister to the hospital at that point, and we only later learned that she'd had a hemorrhage (really, they gave no indication of that in their explanation of what was happening). Several hours later my sister ended up at the hospital because she was still so dizzy and weak from the blood loss.

I can't shake this feeling that the midwives really rushed the third stage, were really rushing to get that placenta out, and that possibly that rushing led to my sister's hemorrhage. I cannot explain why, but this situation has left me feeling very uncomfortable. It just doesn't sit right with me. My sister, despite going through what looked like an exquisitely painful manual extraction of the placenta, is satisfied with her care. I don't really know what I'm looking for here. Am I way out of line to feel so uncomfortable, to have such misgivings about it? Does what they did seem appropriate? (obviously it's hard to say for certain without being there) Thoughts?
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s. The most tramatic birth I have ever attended was my SIL where the CNM pulled the cord and she hemorraged. Very scary! Take care of yourself, be gentle for a few days and find someone to have coffee with

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Thank you both. I never dreamed I'd feel this way about her birth. I always kind of prepared myself for feeling upset about how something went with my own births, yk?, but didn't prepare myself at all for the what-ifs of my sister's birth. Guess I just need to talk about it, but not with her-not now. I'm hoping both that she'll continue to feel okay about it and that she won't continue to feel okay about it (because I can't shake the feeling that what happened was wrong, and when she has her next baby I don't want to see her go through that again. Yk?).
hard to say-- it may have been partially detached-- did you see any blood before she started moving the cord? not long after a birth the cord often looses integrity and can pop off or shred I have had them come off when we were looking at it with the parents-- also one that came off when a mom had a nearly completely retained placenta ( only the very edges were a little detached and mom bled very little for hours, she was in hospital for about 4 hrs before they got to her and she was fine until after removal)
anyway thing is if right after the cord popped off they removed clots probably it was partially separated or fully separated and still in the uterus- because blood has to pool to make a clot it wouldn't be cord pop and instant clot KWIM there would need to be a little time in there.
things to watch for when the placenta is not out-- blood coming out the vagina- anything from a steady trickle to gushes, or the fundus enlarging- now when the placenta is still in you need to be gentle when feeling where the fundus is, if the fundus goes up then there is probably some bleeding either a placenta that is detached and plugging the hole or a clot that is enlarging and the placenta is partially detached.

I have had some very delayed placentas where mom was fine but I would also say that every time the uterus was a fairly tight ball around the placenta and there was no bleeding. I have been at births where the placenta was partially detached and this is scary. Was your sister nursing her baby or holding the baby and focused in on the baby? I have been to several recent births where mom and dad and other people at the birth were all on their phones before the placenta and I have taken to recommending no phones until placenta is out and to really take this time to get to know the baby-- Odent at one of the talks I attended was speculating that distracted moms make for more hemorrhages- that moms that are able to tune into their babies are less likely to bleed.
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Thank you so much, mwherbs.

I didn't see blood before the cord came off-I mean my sister was bloody from the birth, but I saw no gushes or other flowing blood though to be honest if it was just a trickle I wouldn't have noticed or thought it was significant. My sister was holding the babe, looking at him and stroking him, and he was near the breast/touching it but not nursing. And at some point right after the birth there were pictures and Dad on the cell phone announcing the birth-all those distracting things you mentioned. No contractions. Soft uterus.

I did not realize the cord can lose integrity and pop off easily after birth, but that makes sense.

There was a short delay between the cord coming off and the midwife removing clots-I can't say how long. One or two minutes. Probably closer to one minute, time was moving in that peculiarly slow way and I didn't look at the clock. It makes sense that you say it was partially detached because it takes time for clots to form.

The placenta was clearly torn when it was finally out, which seemed to me (in my non-professional, uneducated state) to be consistent with a partially detached placenta.

You've helped set my mind at ease. I really have thought very highly of these midwives, and I honestly think they handled the emergency very well when it happened. After a long talk with my husband about this, I think my discomfort came from being very protective of my sister, from not having professional knowledge about birth, and from my own misgivings about the whole medical model of childbirth (which is a big influence at this birth center, even though they're a big improvement over a hospital). I feel better after reading what you have to say.

Again, I can't thank you enough for sharing your knowledge. I cannot tell you how much you have set my mind at ease about this.
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PMing you.
Hey, after feeling so good in my last post now I feel very upset again.

I asked my sister how she felt about her birth experience, and about the manual extraction of her placenta. I wanted to hear how she was handling it, so I didn't mention my misgivings. She told me that she asked the midwives if that (the retained placenta and hemorrhage) was something she'd have to worry about again. The midwife said "well, it happens. We could have waited a few hours for the placenta, but protocal dictates 30 minutes." So this reinforces my instinct that this didn't have to happen. They were rushing her just to satisfy "protocol", and if they hadn't pulled, if they'd waited for her to have contractions, if they'd given her body a little time to do what it had to do, there's a chance she wouldn't have hemorrhaged and had to go through that-normal loss of cord integrity or not. There was no indication she was hemorrhaging before they pulled-nothing in the midwives words, voices or actions.

This just totally reinforces my belief that birth belongs at home, and my regret about not having my babies at home, and my feeling of being so very lucky that I and my babies escaped the medical birth system healthy and without this kind of trauma. At this moment I feel rather disgusted. When my sister's life has calmed down I will be sharing some research about this issue with her. I don't think this had to happen, and I'd hate to see her risk going through this again. At the very least her decisions regarding her next birth should be truly informed. Protocol.
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The midwife said "well, it happens. We could have waited a few hours for the placenta, but protocal dictates 30 minutes."
Okay, that made me mad! Thirty minutes is nothing! WIth my son, it took almost 45 minutes before the cord stopped pulsing (at which point my MW clamped it) and the placenta was out pretty soon after it was 'done'- maybe 15 minutes later?

A friend of mine had an unassisted birth, and her placenta did not pass for 12 hours. She wasn't bleeding, her uterus was hard- the placenta just did not want to come out! She resisted the urge to mess with it or otherwise panic, and when it did deliver, she did not hemmorage at all.

I hate protocols. They really rip women off. Our bodies are so much stronger and more capable then the textbooks give us credit for!
I would venture to say that the VAST majority of hemorrhages come from mismanagement of third stage.

(Well, that and pitocin inductions.....)
on the one hand, 20 minutes seems awfully short, especially in light of the other extreme (like 12 hours!). And I've seen what I call "shredy" placentas where the cord would just rip right out with a tiny little tug, but that's rare in a well-nourished mother, so there must have been some major pulling going on.

On the other hand, no contractions for 20 minutes, and clots coming right behind the placenta when it did come, would make me very nervous. Probably I would have given some herbs to get contractions going about 15 minutes after the cord stopped pulsating (the key is after it stopped pulsating, not after birth!). Contractions are what cause the placenta to separate, and without them, it won't happen.

I think you're right: protocols probably did play a bigger part in it than they should have...and 30 mintues...what kind of protocol is that?! But I also think there might have been another issue a partial separation, which means your sister was bleeding behind the placenta. It's really hard to tell. If you feel like you know the midwife well enough, you might talk to her about what happened. I doulaed for a friend who had some things go on at her birth that I was unclear about (when you don't know what you're looking for, it's hard to understand what's going on!), and at my next prenatal, I asked my midwife about those things. I wanted to know because I planned to have my baby with her as well, and I wanted to fully trust her with those things. Now that I'm almost a midwife myself, and have been in the same situation at a birth, I know that she handled it well and everything really was okay, but could have been not okay really quickly also. And that's pretty much what she told me when I asked about it.
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