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Old 12-28-2012, 10:10 PM   #11
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Originally Posted by Kiliki
Ugh. This is something I feel pretty strongly about. But for purely personal reasons.

There is varying evidence that says that active management of this stage of labor can be a good way to stop or deter PPH. But, like everything, there are risks. So if you have a greater risk of PPH, actively managing the placenta could be a good idea for you.

Personally, I HATE it. They pretty much RIPPED my placenta out when I was in the hospital, while I was screaming for them to stop. It was actually painful. I could feel it tearing from the inside. It was immediately after the birth - within probably 10 minutes. They also gave my two BAGS of IV pit after the birth b/c I refused a transfusion, which they told me was standard procedure. In addition to that, they came every 15 minutes and smashed the living heck out of my uterus, to keep it tight and clamped down. I did not have excessive bleeding.

With my second labor, it was an accidental UC, and so the placenta had already detached but had not passed yet by the time the MW arrived. She asked me gently if she could just give a little tug while I pushed to help deliver it, and she assured me it was "right there" ready to come out. I knew she was right, and she was very gentle about it, and I appreciated how she handled the situation. I did have bad bleeding after that birth. I almost needed a transfer, and it was kind of scary for a bit. They kept slapping my cheeks and pinching me to keep me awake. I lost a lot of blood. HOWEVER - that labor was just 1.5 hrs start to finish, and my son was over 9lbs, so my uterus was pretty exhausted from all that work. Needless to say, I did stop bleeding so badly and did not need a transfer.

My 3rd birth, another homebirth, I had cord traction again. I was pretty upset, b/c I didn't know the MW would do that. But I think based on my previous birth, she felt it was a good idea. It just wasn't discussed beforehand, so I felt a little frustrated it was done. She was gentle, nothing like the hospital experience, but I would have preferred not to have it. Although I can understand her reasons. I did not bleed hardly at all after that birth. Maybe one week, and only heavy for maybe 2-3 days.

My next birth will be in March. I have the same MW as before, and I have asked her very specifically NOT to use any cord traction. I just don't like it. It is uncomfortable and painful to me, and it isn't something I feel is necessary.

That said, my MW carries pitocin, and should I start bleeding badly, she could administer a dose and I am close enough to the hospital that I could be transported pretty quickly for more care if I needed it. So I wouldn't just bleed out.
I have strong feelings the other way, for personal reasons. (though I don't fault you for your feelings, nor am I contradicting your opinion - just sharing my experience). I doula'd for my friend 6 months ago, and witnessed her experience a severe PPH. She lost 1300cc of blood. The average vaginal birth loses I think inky about 200cc (if I'm remembering that right - someone correct me if I'm wrong). At 1500cc of loss they do a transfusion or a hysterectomy to stop the bleeding. Her PPH came on completely out of nowhere, after 45 minutes after baby and after the placenta was out. The 3rd time they checked her she lost most of it all at once. The nurses handled it really well. They were super calm and took care of her and it her bleeding stopped. We didn't even realize how big f a deal it was until they explained it to the shift change nurses. Before that I'd been vehemently against active management. After seeing my friend face a serious complication - which literally came out of nowhere - I have different feelings about it.

To be fair - I haven't personally experienced active management (other than fundal massage, which I hared). So it's helpful to hear your experience and reminds me to keep in mind that it can be rough on women to experience it.

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Old 12-28-2012, 10:33 PM   #12
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Re: Active management of placenta

i was in the boat of having no cord traction, my body told me to push roughly 5 min after delivery so I did with no assistance from the doc. I ended up having really bad bleeding and needed two bags of pitocin and lots of fundal pressure & massage to get it completely under control. Honestly i don't think i would want the "preventative" measures your doc wants, if need be then sure but not just because something may happen.
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Old 12-29-2012, 07:54 AM   #13
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Re: Active management of placenta

I am fairly certain that in a vaginal birth blood loss over 500 ml is considered excessive, but for & csection this goes up to 1000 ml. My midwife had a birth a few days after mine of an undiagnosed placenta accreta and the mother lost approximately 3 quarts of blood, but was able to make it to the hospital where she did not need a transfusion. (apparently she was a larger woman).
200 ml is probably the low end of normal.
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Originally Posted by BeccaSueCongdon View Post
I have strong feelings the other way, for personal reasons. (though I don't fault you for your feelings, nor am I contradicting your opinion - just sharing my experience). I doula'd for my friend 6 months ago, and witnessed her experience a severe PPH. She lost 1300cc of blood. The average vaginal birth loses I think inky about 200cc (if I'm remembering that right - someone correct me if I'm wrong). At 1500cc of loss they do a transfusion or a hysterectomy to stop the bleeding. Her PPH came on completely out of nowhere, after 45 minutes after baby and after the placenta was out. The 3rd time they checked her she lost most of it all at once. The nurses handled it really well. They were super calm and took care of her and it her bleeding stopped. We didn't even realize how big f a deal it was until they explained it to the shift change nurses. Before that I'd been vehemently against active management. After seeing my friend face a serious complication - which literally came out of nowhere - I have different feelings about it.

To be fair - I haven't personally experienced active management (other than fundal massage, which I hared). So it's helpful to hear your experience and reminds me to keep in mind that it can be rough on women to experience it.
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Old 12-29-2012, 11:24 AM   #14
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Re: Active management of placenta

I had gentle cord traction with all 3 of mine, I didn't feel a thing (maybe the 4th, 3rd and 2nd degree tears were all I could think about?). It was very gentle and slow and about 5-10 minutes after delivery. I never felt like the Dr was yanking or pulling, just sort of helping it slide out.

I required stitches with all 3 of my tears, so I was sort of grateful to get the whole thing over with so I could sit up and get more comfortable after the placenta was delivered and I was stitched up.
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Old 12-30-2012, 12:00 AM   #15
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Re: Active management of placenta

I had two UC and never tugged or even touched the cord until I felt the urge to push out the placenta. I felt it detatch both times. With my 3rd, born in the Hospital, they gave me too much Pit while I was at 8cm, which caused an abruption, and my DD was born WITH her placenta in 1 push. So no traction, but rather a premature seperation caused by intervention. They had to push another bag of Pit through me because I lost so much blood due to the uterine tauma. With my first two, I had such little blood loss that the water wasn't even tinged in the pool. Needless to say, I am heading towards another homebirth with #4 this March/April.
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Old 12-30-2012, 12:15 AM   #16
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Originally Posted by AmeliasMum
I had two UC and never tugged or even touched the cord until I felt the urge to push out the placenta. I felt it detatch both times. With my 3rd, born in the Hospital, they gave me too much Pit while I was at 8cm, which caused an abruption, and my DD was born WITH her placenta in 1 push. So no traction, but rather a premature seperation caused by intervention. They had to push another bag of Pit through me because I lost so much blood due to the uterine tauma. With my first two, I had such little blood loss that the water wasn't even tinged in the pool. Needless to say, I am heading towards another homebirth with #4 this March/April.
What did it feel like when your placenta detached? Mine came out mostly on its own during my homebirth (mw pulled gently bc knew it was already right there), but I don't remember feeling it.
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