Delivering a placenta at a home birth

[scaredbutexcited]

Hi, I am 35 weeks with my first baby and planning on a home birth.

I would ideally like a natural birth (i do appreciate this may not go to plan) but I can't make my mind up what to do about delivering the placenta.

I think on the plus side it reduces the risk of heavy bleed at the time (and I would hate to manage a home birth and then have to go to hospital). However, I have heard that it can mean extended recovery and also that the cord is cut quicker so less support for the baby in the first few minutes (ie they tend to have to cut before it stops pulsing).

Would love to know your thoughts and experiences. I have thought about and researched the first two stages but this has thrown me a bit and can't make my mind up.

Thank you.

[pookamoo]

We left ours till the cord stopped pulsing and then had the injection.
HTH

[Nicknamenotavailableeither]

I had a home birth 4 months ago now, it was amazing!

I didn't have the injection, delivered the placenta naturally. It took longer than I thought, but only 10 or so minutes, so not long really.

I was planning in having injection, but I hadn't had any pain relief (bar hypnotherapy) so midwife suggested I go all natural. You can always have injection to speed things along if the placenta takes a long time to come anyway.

Hth

[ChutesTooNarrow]

I waited, no injection. It sent the midwife into a flap tbh, she kept reiterating I was 'allowed' an hour to try. After about 55 minutes I got fed up and pushed it out. It was hard work, I wasn't expecting that.

I absolutely would have allowed the cord to stop pulsating before it was cut but as I was catching my baby as the midwife arrived she panicked into action and the cord was cut before I realised.

Homebirth was awesome though!

[scaredbutexcited]

Thank you. (And glad your home birth went so well nickname).

I think I will certainly wait until the cord stops pulsing if I can.

If it is ok to "wait and see" than that is even better.

I am so nervous of having a lovely home birth (fingers crossed anyway) and then having to go in for either blood loss or retained placenta. Being at home afterwards with my DH and in my own home is one of the main reasons why we are trying for a home birth.

[thing1andthing2]

I waited and waited for the placenta to come naturally after my 1st home birth. After about 35 mins the mws were getting me to squat and push and I didn't like it (I was knackered) so I asked for the injection and it was all done and dusted in 5 mins.
Second time the mw was encouraging me to deliver the placenta naturally but after 5 mins of push/squat I said "let's just get it over with" and had the injection again. This second time the injection made me vomit which was a bit rough but I preferred taking that risk to spending ages trying to push it out.
Wait and see is the best approach, I don't think there is a time limit on having the injection.

[fivepies]

I had a wonderful homebirth last Friday. Delivered baby in a birthing pool and got out for the placenta. I moved onto the sofa, midwives wrapped me in a blanket while Daddy had some skin to skin time with baby. It only took a couple of pushes and a couple of puffs of gas and air to deliver the placenta without the injection. Ten minutes, that's all. Did have the injection available, but didn't need it luckily.
Best of luck to you for your birth.

[blossombath]

I had a home birth a year ago and would echo the wait and see advice above - our antenatal teacher said that the negatives/benefits either way are so well balanced that it's often better just to go with whatever your MW is most comfortable with/advises at the time. So that's what we did, and the MW, like one above, said why not try without it since I had had no drugs up until that point (except a sherry and some OTC co-codamol).

We waited for the cord to stop pulsing; cut cord; DS taken from me and given to DH while I stayed in the bath and pushed out the placenta - 15 minutes from birth to placenta delivery, and that included my skin-to-skin and cutting cord etc.

If you can, I'd tell your MW (or get DH to tell MW) as early as possible about your fears on bleeds/retained placentas - that way she can put your mind at ease and understand what your wishes are when it comes to that point. They will have your best interests in mind and won't want to rush you to hospital either.

[PickleSarnie]

I didn't have the injection. Just sat for 30 minutes after feeding my son then the midwife asked me to get up and squat above a bucket. Placenta literally plopped right out with no effort.

[Arithmeticulous]

My IM has a thing about 18-22 minutes being usual for a natural third stage. As in, most will come by then with a quick push if it hasnt already.

Much better than the NHS midwife who went all at the idea and didn't know when the cord had stopped pulsating because she hadnt seen one in so long, then pulled and pulled on the cord whilst huffing and puffing about how long it was taking (15 mins) and then insisted I have the injection afterwards as I was "gushing" and then wrote in my notes a blood loss of 200ml - tbh if I'd realised how uncomfortable and inexperienced she would have been with a natural third stage, I would have done things differently.

[abbyfromoz]

Hello. I had my DD in an MLU...wanted totally natural birth and had a complication free pregnancy (despite severe morning sickness) so i did. Gave birth in just under 10 hours after labouring in the water for pain relief to a perfect 10.5lbs baby girl. Unfortunately after the very straightforward (but not painless) birth i was heavily bleeding, given synticonin and unfortunately the chord snapped with placenta still inside. I was given a further 2 doses and tried to have placenta manually removed.... Drug free (no words to describe pain)... The synthetic oxytocin was horrifically painful esp considering dosage and i ended up in theatre 3 hours (!!!!!) later with an immobile epi to have it surgically removed (ironic). Next pregnancy i will be having the baby weight monitored and consult an obstetrician before labour. No one predicted her size (which was the cause of heavy bleeding and large placenta) so i am not sure what i would do... All i know is that drug is NOT my friend... Sorry don't want to scare you but thought it might be relevant to your questions about what to do...congrats on bubba!!

[binkybonk]

I was so unsure what to do about this/ write on the birth plan with DS1- in the end I had a natural birth and avoided pain relief as I'd wanted and then I just said 'give me the injection' and didn't even notice it or the delivery of the placenta as was merrily staring at the new being... DS2 born at home 4 weeks ago and over here (not UK) there is no option of any pain relief or medical intervention at home, so once you've started you have to finish, so to speak! I decided to not have the injection- big decision as if the Dr doesn't bring it initially in pre approved kit it just isn't here- it's a hospital trip if you need it. I gave birth to DS2, we all felt the cord pulsing and talked about it, when it stopped my husband but the cord and popped the tie on and I kid you not, the midwife said 'cough now' and I coughed and the placenta slid out!!! Bizarre
What I'm getting at is, bar any medical necessity as above, is that you hopefully won't care/ notice because you will be distracted by a bundle of loveliness. So put down what you feel you want but there's no harm in changing your mind

[Celia1978]

I'd asked for natural 3rd stage at my home birth. In the end the mw recommended injection because I'd been pushing baby out for ages. Was happy to agree at this point! But I did request they hold off a little bit to get as much cord blood as possible which they were happy to do and in the end the cord stopped pulsing very quickly before they needed to do the injection so it was all good.

Glad I had the injection: I lost a fair amount of blood - not enough to be classed as haemorrhage but getting that way - and it definitely felt like the right decision.

Also I was very concerned about retained placenta in advance of the birth. Was relieved to see they give it a really good going over once it comes out to make sure it's all complete!

Good luck with your birth. Hope it all goes well.

[LeBFG]

I wasn't too bothered about a natural 3rd stage but I did want a delayed clamp so had to employ an independant MW. She just said she had no experience of the injection (probably did but just didn't want to do it) so I had a natural 3rd stage. I'm glad I did. Placenta came out double quick in the end - really no bother. Bleeding since has been much less than first time round with injection - not sure if linked but I'm pleased with the outcome. However, I believe you can have delayed clamping whether or not you have a natural 3rd stage.

[VisualiseAHorse]

I had delayed clamping and had the injection. I remember asking the MW while I was still in the pool 'don't cut the cord until it's stopped squeezing' - I think she got what I meant!

Had the injection, placenta out very quickly.

[scaredbutexcited]

Thank you for all your thoughts and experiences.

I think I will say delayed clamping and then aim for a natural third stage. I will listen to the midwife on the day though and have the injection if she thinks it is necessary.

I guess as a lot of you say, hopefully at that stage I will be enjoying meeting my daughter so won't care too much either way!

Thank you for your advice.

[VisualiseAHorse]

Good luck :)

[AmandaPayne]

I had a homebirth and a rather stubborn placenta.

We had delayed cord clamping and then had been planning for a natural third stage. When it looked like the placenta wasn't keen to budge, I had the jab. The whole palaver took nearly an hour, but the midwife was very calm and relaxed about the whole thing. The second stage had been rather surprisingly fast and the midwife said that the shock of this sometimes resulted in a bit of an adrenalin surge which slowed things down.

One thing to bear in mind is that I had originally thought I might ask for the jab but delayed for delayed clamping (ironically what happened!). I was told many midwives aren't keen to plan for that. That's because the benefit of the jab is (as you've said) decreased risk of high blood loss and the risk is retained placenta. By the time you've waited a bit, it presumably doesn't look like your blood loss is worrying and the risk of retained placenta gets greater. So really it's losing the best benefits of both approaches. They'll generally only do it if there seems to be a problem- like the placenta isn't budging or you suddenly seem to be bleeding more than they'd like. That's obviously not the view of every midwife from posts above, but it was certainly the view of my local team.

[Dillydollydaydream]

I had a homebirth for dc3. I had planned a natural 3rd stage.
The midwife didn't arrive in time though so the cord was left pulsating for about 1/2 hour or so and was cut after the mw had arrived, I had to squat to deliver the placenta but it wasn't to hard to do and I didn't have a big blood loss.
This time I'd like to have a planned delayed cord clamping.