Delivering the placenta

earthgirl · 08-16-2006, 10:39 AM

I've only done 5 births so far, so my experience is minimal. It's only been in the last 2 births that I realized that they (med staff) chart the placenta delivery time. In my most recent birth, the baby was born at 4:00, Mom was Rh- (so I know traumatic placental delivery needs to be avoided)Placenta came on it's own at 4:30 (I thought this was b/c the Rh factor), then the OB was charting and asked when was the placenta delivered? When told, he exclaimed I can't write 4:30! This was the only birth I've attended where the OB didn't use traction to deliver the placenta. I guess my question is this: Is delivery time the only reason traction is used, or are there other factors?

jesscardona · 08-16-2006, 10:42 AM

Can you explain this a little more...

~Tranquility~Doula · 08-16-2006, 10:45 AM

There is no reason that traction should be used to deliver the placenta. Docs just do it to speed up delivery time so they can get out of there.

earthgirl · 08-16-2006, 10:50 AM

Sorry if it's confusing. Sometimes the placenta is birthed on it's own with contractions, and sometimes they will pull the placenta out by the cord shortly after the baby. What's the rush?

AussieDoula · 08-16-2006, 10:59 AM

Most doctors will say it's because active management of the third stage decreases the risk of primary postpartum hemorrhage.
This is usually baloney, and is often done just to save time.

I could spend all day in this thread because cord traction is a pet peeve and gets me fired up, but for the sake of remaining calm...

earthgirl · 08-16-2006, 11:06 AM

Thanx Aussie! I thought it was just me! I was so excited the last birth, b/c he didn't, but I guess it was just an oversight on his part. He didn't want his OB Group to know the placenta came on it's own a whole 30 minutes after the baby!

AussieDoula · 08-16-2006, 11:07 AM

Quote:

Originally Posted by ~Tranquility~Doula

There is no reason that traction should be used to deliver the placenta.

Not entirely true, as women with a high risk for complications/PPH could benefit from active management of the third stage.
However, as a general statement, yes I agree: There should be no need to use cord traction to deliver the placenta in a low-risk mama.

MamaAshley · 08-16-2006, 11:08 AM

All I know about this subject is my personal experience. With my first two babies my midwives use no cord traction, and with my 3rd baby for some reason my midwife (a different midwife practice) used traction and I hemorraged very badly almost needing a blood transfusion. This subject also weights heavily on me so I won't get into, but I will just ask WHY DO THEY DO CORD TRACTION?????

jesscardona · 08-16-2006, 11:10 AM

sorry if I sound dumb, but doesnt the placenta kinda delivers on its own?
or does the doc actually has to get in there and take it out?

AussieDoula · 08-16-2006, 11:11 AM

Quote:

Originally Posted by earthgirl

Thanx Aussie! I thought it was just me! I was so excited the last birth, b/c he didn't, but I guess it was just an oversight on his part. He didn't want his OB Group to know the placenta came on it's own a whole 30 minutes after the baby!

Ugh, I can't believe his reaction. What an ...

Anyways, do you cover the delivery of the placenta in your prenatals? Maybe it's something you can help mamas incorporate into their birth plans in the future. Most mamas really don't give much thought to the placenta (most women can't even remember delivering it lol), but tugging on the cord can cause so many postpartum problems.

I'm glad you got to see one being spontaneously "born"!

AussieDoula · 08-16-2006, 11:29 AM

Sometimes the placenta really does have trouble coming away and out on it's own, so manual extraction is necessary, but this is very rare as far as I know.

The risks of cord traction in a normal birth can include the cord breaking, retaining pieces of the placenta as it is torn from the uterus, scarring, endometriosis, infection, rupture, tears, hemorrhaging anyway, and I could go on... Not to mention the emotional damage and trauma that can be caused by having hands inside you moments after your child's birth and tearing/scraping your placenta out (full manual extraction).

One mama I've heard of had a routine (unnecessary) manual extraction with her first birth and she has now hemorrhaged after each subsequent birth as a result of scarring on her uterus due to the "ripping" out of her placenta.

It's such an important thing to include in prenatal discussion. We owe it to our mamas to help them make educated decisions about routine procedures.

earthgirl · 08-16-2006, 11:38 AM

I do cover placental delivery in my prenatals. And I talk about delaying cord clamping, so the baby gets it's full blood supply, and preventing possible neonatal anemia etc. OB's often question this also when it's in the birth plan. The last OB started explaining the blood exchange system of the placenta like a mechanic, and got me so confused. I wish they didn't rush out of there so quick so I could ask some questions.

AussieDoula · 08-16-2006, 11:53 AM

It can be so hard working with OBs LOL!
I wish more mamas would trust their instincts, and not let their doctors talk them into things they don't feel comfortable with.
OBs spend a lot of time questioning things that they'd rather not do (hehe) which is why mamas need to make sure their CPs are right for them... I know that it's mamas decision in the end, but it makes me so "GRRRR!" when her wishes are ignored (often deliberately and for no reason other than doc's ego) and she is subject to interventions she didn't want or even need.

I'm glad you spend time talking about it with your mamas, but it makes me sad that out of 5 births only 1 has had no cord traction (which may have been an oversight/fluke judging by the OBs reaction). Did the other mamas choose to have it done after considering it, or was it done as "routine" with no/little explaination in the moment?

I love that you have questions, it can be difficult to be more assertive and ask all of them during a mama's prenatal when the doctor is trying to make a quick getaway (for myself though, I ask a million questions at prenatals with CPs that mama seems to have forgotten/is too timid to voice)...

jesscardona · 08-16-2006, 12:02 PM

OB's think that having a baby is
A mother comes preg.
Mother lies on bed
Mother gets IV with fluids and pitocin
Mother gets epidural
Doctor comes every 3hrs to check cervix
Doctor comes takes baby out
Doctor takes placenta out
Doctor walks out of room

wendoula · 08-16-2006, 12:04 PM

Its standard here at the hospital for them to give you a pitocin shot right after birth to speed up the delivery of placenta- I talk about placenta delivery and the love hormones and how important that the mom keep the baby skin to skin becuase it helps release the hormones to be able to release the placenta and that pitocin is not needed - only if its an emergency for possible hemmorrage.

The whole traction thing is not necessary - the plancenta will come out on its own. Its all about managment and time for the Dr.