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Old 12-26-2012, 11:37 PM   #1
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Active management of placenta

What are your experiences with this - shot of pit after birth, traction of the cord to assist in removal of placenta and clamping cord w/in 3 min.

My OB is pretty crunchy and is comfortable with my minimal intervention wishes. His only requirement is a hep lock - which I am fine with. He told me last week that he prefers active management and that WHO recommends it. And that its a very effective preventative for PPH. I read up on it and it seems that both sides have supporting data.

My big issue with it isn't with the pit, I was induced last time, so a shot of it at the end doesnt seem like a big deal. I discussed with him today that I was really worried about him pulling on the cord. He assured me he was going to wait until it appeared there was separation on its on and wouldn't "yank" it out so he could leave to go skiing. Or pull my uterus out. I do trust him, so I don't think he's just telling me what I want to hear. Pretty sure that if I say I don't want him to do it, he'll go along with - barring emergencies.

With my first, I really don't remember what was happening with the placenta. I was focused on the baby and only remember the mw holding it up from across the room to show me the calcifications.

Delayed cord clamping isn't really that big of a deal to me, we did it the first time and the baby still got jaundice.

Experiences?

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Old 12-26-2012, 11:52 PM   #2
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In both of the hospital births I have doula'd for, they did active management. Both times they were very VERY cautious with pulling the placenta out with cord traction. I do know that the reason care providers like to actively manage it is that letting the placenta sit can *potentially* hide PPH. It can pool inside the uterus but be blocked in by the placenta which has partially or fully detached and is blocking its exit. You could ask him what other options you could try to help get the placenta out. I can understand your concern. While most providers would be gentle and do it properly, it's something that could surprise you if they happen to not be gentle.

Talk to them about having immediate skin to skin time immediately after baby is born, before they clean or cut the cord. Getting baby to the beast immediately can help with speeding along the third stage. The nipple stimulation and baby kicking around and pushing your belly with their feet help to stimulate contractions and shrink the uterus. Plus if you're snuggling baby and focusing on them, then usually the third stage goes a lot more smoothly. :-)
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Old 12-27-2012, 12:00 AM   #3
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The hospital is very baby friendly. They do immed skin to skin, breast feeding, exams on mom and waiting an hour before the heel prick or eye goop.

That's why I can't remember what happened last time, I was too busy meeting baby and nursing.
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Old 12-27-2012, 09:29 AM   #4
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Re: Active management of placenta

Here is a great article that might help your research. It helped to give me some perspective.
http://midwifethinking.com/2012/05/0...or-most-women/

I did not have a shot of pit after either birth. I wouldn't have been averse to it if necessary, but it wasn't. The first was in a hospital and the second one at home. Even without the pit at my first birth the doc did use gentle cord traction. I bled very little, though.
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Old 12-27-2012, 09:35 AM   #5
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Re: Active management of placenta

It took me 45 minutes to pass the placenta. I don't know what average is, but it seemed like a lot longer than my previous births and like the nurses and OB were getting anxious. I didn't have any pit. My OB did VERY gently pull on the cord periodically. It didn't hurt and if I even started to twitch, she would immediately stop. In the end, we just had to wait for my body to do what it needed to. Once it was coming, she did pull as it slid out, but it didn't bother me.

Honestly, I had no idea there was any issue or possible controversy over delivering it, except possibly with getting pit or having the OB remove it manually in some type of emergency. So, it didn't even occur to me to ask about it. I do know I didn't have pit. I didn't have a IV (or hep-lock) and no shots.
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Old 12-27-2012, 02:28 PM   #6
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This is a stage of birth I had forgotten about.

Interesting, interesting....
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Old 12-27-2012, 03:04 PM   #7
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I've never had pit to deliver the placenta. Both times times I've delivered it with in 10 minutes of the delivery.

And delayed cord clamping is not done to prvent jaundice. Delayed cord clamping is done to body babies iron levels and give them all the extra stem cells from the placenta.
http://mobile.bbc.co.uk/news/health-15736550

I'm mobile.... sorry for the typos!
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Old 12-28-2012, 07:38 PM   #8
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Re: Active management of placenta

Whatever you're comfortable with - but I do want to mention, there is absolutely no reason or benefit to your or your baby to have your placenta pulled or yanked at. None. It carries risks and no benefits, so I would definitely do some research there. It seems mostly to be in the benefit of the OB. I had a shot of pit with DS1 because my mom hemmoraged at her births, but decided not to do it with DS2 unless I started to bleed more than what was normal, and I never did. I'm glad I declined. There is really no reason to do it unless you're really bleeding. The placenta will come out in it's own time. I didn't delay cord clamping with either of my boys. The first, I didn't research it at all, and with the second I acutally wanted it clamped sooner. Not clamping right away prevents iron deficency, but clamping right away actually helps prevent jaundice. DS1 had bad jaundice and DS2 had very, very mild (so who knows) but both have really great iron levels. HTH
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Old 12-28-2012, 08:15 PM   #9
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Re: Active management of placenta

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.
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Old 12-28-2012, 09:54 PM   #10
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Quote:
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'm so sad to hear that you had those experiences. :-(. I know that doctors do the active management to avoid more severe problems. But it obviously doesn't address the comfort and emotional experience of the mama. :-(

Does anyone have experience of active management that wasn't a difficult one? I've had one CS and then my hbac wasn't actively managed. My MW did do gentle cord traction and fundal massage, but my placenta came spit easily and I didn't feel her pull on it. I lost a lot of blood too. But didn't end up transferring.
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