Hi!
My latest birth was a beautiful birth, and mom did so good! The ending was a bit rough which was disappointing.

Mom texted me at 4:30am. Suspected water leaking since 6am previous morning - but no gush. She was contracting every 5 minutes if standing, but slowed to every 10 minutes if lying down. Contractions had become somewhat regular but far apart at 11pm the night before. Now she feels like she needs to bm with every contraction and is shaky. She wants to know if it's time to wake up dad. Um, well - it sounds like you need some support, so yes, and I will be there soon!

When I arrived soon after she was 4 minutes apart. We started some accupressure and relaxation, took a potty stop and a lap around the dining room table. 30 minutes later she is 3 minutes apart and shaky. I tell dad to get ready, and text the babysitter.

We get to the hospital around 6:00a. It takes 15 minutes for someone to get us up to the labordelivery floor. Then they have us try to potty for 15 minutes. Mom at this point is every 2 and zoning out during contrax. We are continuing accupressure for pain and cervical dilation. After unsuccessful potty time the nurse has her get into bed and wants to monitor for 30 minutes. Uhuh - I don't think we're gonna get 30 minutes of tape.

The nurse gets mom hooked up to monitor and checks dilation - she is 7-8cm. Immediately nurse #2 comes in and checks again, and confirms 7-8cm. They quickly call the doc.

10 minutes later baby is crowning! Doctor did not make it in time. All nurses on deck! Three pushes and baby boy - 9lbs, 21 inches - arrives beautifully. There was some bruising on the face "from too fast a delivery" (but i'm thinking it was an overzealous helper with the head), and a minor tear.

Doc showed up right after the baby's cord was cut. The baby was immediately whisked away to the warmer for all of the typical tests. not happy about this - and neither was mom. Baby was fine.

All before - BEAUTIFUL! Now time for the placenta. Well - maybe not. After 25 minutes the placenta had not separated, and the doc has a 30 minute time limit. She tells mom the time limit and in order to avoid surgery begins firm massage repetitively on the abdomen. Poor mama! No time to get a pit i.v. started? - and no one suggested an i.m. pit. Then multiple internal attempts to dislodge the placenta manually. This was a new one to me - and something I'd prefer not to have a mom experience again.

Besides the intense pain mom was going through - my main source of extreme aggravation was with the nurses not giving baby back to mom to try nursing to begin contractions!

Doc retrieved the placenta, and ordered a round of antibiotics.

Baby and mama are doing great. It was a beautiful labor watching her do her own thing at home, and not have to be stuck in a bed at the hospital for too long.

Sounds like a good pee would have brought the placenta, but who knows. Curious why they didn't cath first or run some pit. 30 minutes is not all that long, even for an OB.

Manual removals are rough. I have done one. I hope to never do one again. These are great things to discuss with OBs before - plenty of OBs think its no big deal to manually remove a placenta or sweep for clots. After all, the vast majority of their patients are going to be numb and antibiotics (almost) remove the almost certain risk of uterine infection.

On the other hand, if patience is impossible, I would rather have an OB manually remove a placenta than preform some of the crazy cord traction I have seen and risk an inversion.

I've only seen a manual removal once - when the cord snapped due to a velamentous insertion. The placenta was already separated and sitting at the cervix so it was not too traumatic for the mom. 30 minutes seems like a ridiculously short period of time to wait and to do nothing else before a manual removal is just...unbelievable.

That's horrible. I've been told that 2 hours is the max for waiting. Did she have a birth plan? It should always include spontaneous placenta delivery. I'm glad she had you for support!

My last client had a manual removal. It had been close to an hour and she was losing a lot of blood. The placenta had calcified and then my client passed out and her BP read 80/50! I was slightly terrified. But all is well, now.

The doctor had to reach in and help get mine, I'd had an abruption and was bleeding severely but it was only partial and needed to come it completely as it had been partially abrupted for about the last 2 hours of my labor! I don't remember any pain, but I was so light headed and out of it from blood loss

However if your client was mentally present, did she not try to say no? And why didn't she ask for baby to be brought back to her? I know sometimes they do these things automatically --- but she can speak up at any time!! Did you encourage her to? I always remind my clients when they are veering from their birth plan. I encourage them to ask questions or voice their wants any time something is going "off".