cord and placenta

[cyerge]

after my client birthed her baby yesterday, her dr. continued to pull on the cord, so much so that the cord separated from the placenta. there was so much blood and blood clots and she had to scrape her inside to expel the rest of the placenta. has this happened to anyone? how dangerous is this for the woman?

[DL]

Pulling on the cord is called "cord traction". It is horrible when the cord is pulled so hard that it separates from the placenta. It's even more horrible when care providers have to manually extract the placenta because of that. It is a very painful and traumatic thing for the mother.

I did see the cord come off of the placenta recently, but not because of cord traction. The case that I'm referring to was a case of placenta incretia that did not show up on u/s (where the placenta had grown into the cell linings of the uterus where mom had previous surgery to correct a uterine septum), and was basically stuck onto the uterine wall not to be expelled naturally. In this particular instance, parts of the placenta started to come apart when mom's uterus started contracting trying to expell it. The cord came off with some parts of the placenta. The Midwife and eventually the OB had put their hands/arms up to try to find out why the placenta wasn't coming in one piece along with the cord. Once the incretia was discovered, mom was taken into surgery under general anesthesia to separate the placenta from the uterine wall. Mom even had a blood transfusion. It was simply awful. Mom and baby are doing well now, and fortunately, mom didn't have to have a hysterectomy, which is very common with this type of complication. It was an experience that I'll be happy to never have to experience again.

[DL]

Quote:

Originally Posted by cyerge how dangerous is this for the woman?

I forgot to answer that it could be very dangerous. The mom is much more likely to hemorrhage in this situation.

[birthisnatural]

[Stacie]

My best friend had an accreta with her first baby, and then a percreta + previa with her fourth baby (who was delivered early to save my friend's life -- baby did not make it; she also had major anomomlies incompatible with life including gastroschisis, which by itself can be fixed, but hers was so bad they could not tell visually if she was a boy or a girl).

Accretas, incretas, and percretas cannot always be found on an ultrasound. She also lost her uterus after her last birth. After her first birthm, she needed a transfusion...after the 4th birth, she needed 7 units of blood in 3 days.

The year anniversary of Claire's birth/death is coming up in the 19th.

I had a client with a portion of retained placenta which caused contiuous hemorrhaging, requiring a D&C about an hour after birth. I had another whose placenta would not come, and the midwife manually removed it -- both in the last year.

[Doula Hara]

that sounds horrible! i hadnt heard of this at all. is this something that most of you cover in possible medical interventions with clients? i feel like if i was at a birth where the care provider began to pull on the cord, i would feel compelled to warn my client of the potential consequences...strongly. how appropriate is this?

[ctowndoula]

Quote:

Originally Posted by Doula Hara i feel like if i was at a birth where the care provider began to pull on the cord, i would feel compelled to warn my client of the potential consequences...strongly. how appropriate is this?

This would be outside the scope of practice for any doula organization, it would set you up to be thrown out of the hospital, it is almost at the point of giving medical advice, etc. You can talk about it prenatally all you want, you can set up code phrases so dad knows that something being done is not supported by evidence and he can start asking questions, you can ask innocent questions (have to be careful there ) of the doctor, you can teach couples to always ask for information on any studies done on what is being done/suggested. If mom declines and it is being done anyway, you can say "I hear her declining the procedure."

As doulas, we got into this (many of us anyway) to help women and educate them. We CAN'T save them. I can think how great it would be be to have had someone standing there asking staff to please provide proof of safety for that procedure or back off. But we can't do that. Sucks don't it?

[tlcdoula]

Quote:

Originally Posted by ctowndoula This would be outside the scope of practice for any doula organization, it would set you up to be thrown out of the hospital, it is almost at the point of giving medical advice, etc. You can talk about it prenatally all you want, you can set up code phrases so dad knows that something being done is not supported by evidence and he can start asking questions, you can ask innocent questions (have to be careful there ) of the doctor, you can teach couples to always ask for information on any studies done on what is being done/suggested. If mom declines and it is being done anyway, you can say "I hear her declining the procedure." As doulas, we got into this (many of us anyway) to help women and educate them. We CAN'T save them. I can think how great it would be be to have had someone standing there asking staff to please provide proof of safety for that procedure or back off. But we can't do that. Sucks don't it?

I agree - it is outside our scope at the birth, but can be talked about prenatally.