Question on placenta delivery

starlightstef · February 2013

I've been putting together my birth plan and I'm a little torn about whether to do a natural or managed placenta delivery. I'm doing hypnobirthing which recommends no pitocin and no cord traction. I discussed this with my midwife and she's totally fine with that if that's what I want. However, she would typically administer pitocin right after birth.

I've been trying to research both choices and it seems like there's pros and cons for both routes so I really don't know what to do. What did you do and why did you make that decision?

AmyRI · February 2013

Well, I only found pros for getting the pitocin. I didn't find any cons, so I had it both times. And both times I didn't even notice it. I was far too busy soaking in the new baby.

What cons have you found?

MitoRachel · February 2013

I have a dumb question... If you are doing delayed cord clamping and you get pitocin right after delivery will the pitocin get to your baby?

starlightstef · February 2013

It makes some women sick (nausea, vomiting, headaches, dizziness, etc), which for some makes it difficult or impossible to hold their new lo. In rare cases, it can also cause the uterus to contract too quickly and retain the placenta, which would then require surgery to remove.

starlightstef · February 2013

MitoRachel:
I have a dumb question... If you are doing delayed cord clamping and you get pitocin right after delivery will the pitocin get to your baby?

I've wondered this myself as I will be doing delayed cord clamping. I think my midwife might have said they can do the injection after the clamping, but don't quote me on this because yesterday was total information overload for me.

Nechie122 · February 2013

I think this is one of those things you can play by ear. I didn't have Pitocin and delivered the placenta very quickly after the baby, almost immediately. But I think if it's stretching on or there's concern about bleeding, the benefits of Pitocin at that point would outweigh any potential risks.

aylafsu88 · February 2013

I did not get it but would if I needed it for hemorrhaging. I have not heard of any cons about it but I did not look into it much. I figured if I needed it, I would get it.

dosafyre · February 2013

The first time I had IV so they asked if they could turn on some pitocin at the end, and the doc gave some tension to the placenta to help it deliver a bit quicker.

The second time I got the shot in the leg soon after delivery (we let pulsing happen for a bit, but I honestly can't remember if the shot came before or after...I figure it was close enough baby likely got none or very, very little). I delivered the placenta naturally, and definitely had to push it out and I noticed how uncomfortable it was making me as soon as it detached. I also bled more with this birth...to the point where it started to get concerning and counting the fist-fuls of blod clots they were taking out. I'd much rather have the shot then have needed a blood transfusion.

IMO...placenta is no big deal either way. And definitely get at least the shot.

abell77 · February 2013

I would ask for no intervention and then see how it goes. With my first I delivered the placenta with no help whatsoever. With my second I was having a little more bleeding than they would have liked to see, so I did end up getting a shot of pitocin and they were massaging my stomach to help encourage the placenta out to see if that would stop the bleeding. But they didn't automatically start these interventions, they were implemented as needed. Sure, there might not be many significant cons to having them help it along, but the way I see it is that if this is a process my body is intended for, then let my body do it.

MamaAloha · February 2013

hey we have the same EDD!

I asked a kind of similar question here a little while ago ("talk to me about pushing out the placenta") and people gave a ton of great answers, you could scroll down and see what all they said.

I'm a FTM so no advice here, but after hearing all the responses I'm certain that I'm going with the no intervention unless medically necessary option. I think my body can finish what it started!

Good luck fellow 3-27 mama!

drpayne · February 2013

Nechie122:
I think this is one of those things you can play by ear. I didn't have Pitocin and delivered the placenta very quickly after the baby, almost immediately. But I think if it's stretching on or there's concern about bleeding, the benefits of Pitocin at that point would outweigh any potential risks.

This. It seems kind of odd that she just gives it routinely.

oliversmommy32912 · February 2013

I don't understand why they would give pit without seeing if the placenta would come easily on its own. Maybe there is a benefit I don't know about? I definitely see the benefit of using it after the placenta is delivered...but before?

My placenta came about ten minutes after delivery. My MW did use gentle traction but it was very little and the placenta came very easily. I did get pitocin after the placenta was delivered because I was bleeding a lot and they wanted to err on the side of caution. I didn't even notice. I feel the pros definitely outweigh any cons if there is any question of hemorrhage.

iris427 · February 2013

oliversmommy32912:
I don't understand why they would give pit without seeing if the placenta would come easily on its own. Maybe there is a benefit I don't know about? I definitely see the benefit of using it after the placenta is delivered...but before?

Because giving Pitocin routinely significantly decreases the incidence and severity of PPH. It's easier to prevent a hemorrhage than treat it once it has begun. PPH is still a leading cause of maternal morbidity and mortality in the US and around the world.

The side effects of third stage Pit are minimal. And since the baby has already been born, it won't adversely affect the baby or the birth. We talk a lot about evidence-based medicine here. Well this is one of the cases where the evidence is there and it supports the routine use of third stage Pit as the practice that results in the best outcomes.

OP, I think either choice is fine. But if I were delivering in a hospital and my provider preferred to give Pit routinely in third stage, I would save my battles for something more important and go along with this one.

PansyPants · February 2013

I didn't make that choice. I didn't have an IV so they didn't immediately give me pitocin for placenta delivery. It just came out while I was bonding with baby and then after a few minutes they told me they were considering giving me pit because of bleeding but it slowed before they got to the shot.

My current OB has said that he will give me a pit shot if I hemorrhage but otherwise he just plans on leaving it up to my body.

I honestly didn't realize there were pros/cons to this but I'll look into it a little more.

Celyn · February 2013

The one major con: Pitocin can inhibit the oxytocin-induced milk ejection reflex and thus impact breastfeeding.

headgear03 · February 2013

I have had three nutrual water births where we delayed the cord clamping . We waited till the placenta was delivered and the cord turned white before we clamped the cord . My midwife promotes immediate breast feeding which in normal cases helps the uterus contract and does the job the potocin would. I know my midwife would use potocin if needed but tends to do what's natural first. I'm hopeing for a fourth water birth in July and will follow the same plan.

BriDaily · February 2013

Ah ha! I had to look this one up!

After delivering my DS in the water and doing delayed cord cutting, I got out of the birth tub to deliver my placenta. My midwife had me take an herbal extract and I believe it was Motherwort. Motherwort is good for uterine support and has antispasmodic properties making it perfect for after delivery! I believe the extract was mixed in some water, although you could also put it in juice or something like that. Personally, I would rather go with a natural remedy with fewer side effects and risks than a drug that has loads of known side effects!

The other great thing to do after delivery is start breastfeeding right away. The release of oxytocin at this point with help with uterine contraction to help deliver the placenta. Don't freak out if it takes about 20 minutes to deliver the placenta... that's about how long it took for me to deliver mine. With #2, I am planning on doing a partial lotus birth, so we won't be cutting the cord for a few hours (until it has dried up). I am also going to be doing placental encapsulation. Super excited about having a different experience this time around!

MrsBigTime · February 2013

I had a dose of Pit after the cord stopped pulsing. I don't know if my MW put tension on the cord or not, I was so wrapped up in my daughter I didn't really even notice what was going on.

AmyRI · February 2013

Celyn:
The one major con: Pitocin can inhibit the oxytocininduced milk ejection reflex and thusnbsp;impact breastfeeding.

Do you have more info on this? I can only seem to find 1 study on it, and it only discusses changes in hormone levels and nothing about the actual impacts to breastfeeding. And the study also said that an epi had a detrimental impact, which I haven't heard before.

Jdunk2008 · February 2013

Celyn:

The one major con: Pitocin can inhibit the oxytocininduced milk ejection reflex and thusnbsp;impact breastfeeding.

You do know that PITOCIN is the synthetic form of oxytocin right?

Celyn · February 2013

LOL. Yes, I'm aware. Given that it's synthetic, it gets processed not entirely the same as natural oxytocin. Oxytocin plays in huge role in how much milk a mom will make. It binds to the oxytocin receptors in the mammory glands.

Intravenous Pit does not bind in the same way and intravenous dosing does not affect the brain in the same. To explain in a simple way, the body is a bit fooled into thinking it's already done it's work, and doesn't release the same amount of natural oxytocin (just as ?-endorphins are affected when Pit is used). Lower levels of oxy are made by the pituitary gland, and less of it finds its way into the CNS. The oxytocin receptors get desensitized. Pit is also an antidiuretic, so administered with a full bolus, can lead to more engorgement than is typical in a new mom, making latching more difficult.

All this combined puts a new mom behind the curveball, more so if she received Pit throughout labor (with as little as 6 hours having a significant effect) than in the last stages.

If you would like to study references, I can look them up for you.

iris427 · February 2013

Celyn:
LOL. nbsp;Yes, I'm aware. nbsp;Given that it's synthetic, it gets processed not entirely the same as natural oxytocin. nbsp;Oxytocin plays in huge role in how much milk a mom will make. nbsp;It binds to the oxytocin receptors in the mammory glands. nbsp;Intravenous Pit does not bind in the same way and intravenous dosing does not affect the brain in the same. nbsp;To explain in a simple way, the body is a bit fooled into thinking it's already done it's work, and doesn't release the same amount of natural oxytocin just asnbsp;endorphins are affected when Pit is used. nbsp;Lower levels of oxy are made by the pituitary gland, and less of it finds its way into the CNS. The oxytocin receptors get desensitized. nbsp;Pit is also an antidiuretic, so administered with a full bolus, can lead to more engorgement than is typical in a new mom, making latching more difficult.All this combined puts a new mom behind the curveball, more so if she received Pit throughout labor with as little as 6 hours having a significant effect than in the last stages.If you would like to study references, I can look them up for you.nbsp;

I'm interested to see them if you have the info handy.

AmyRI · February 2013

iris427:
Celyn:
LOL. nbsp;Yes, I'm aware. nbsp;Given that it's synthetic, it gets processed not entirely the same as natural oxytocin. nbsp;Oxytocin plays in huge role in how much milk a mom will make. nbsp;It binds to the oxytocin receptors in the mammory glands. nbsp;Intravenous Pit does not bind in the same way and intravenous dosing does not affect the brain in the same. nbsp;To explain in a simple way, the body is a bit fooled into thinking it's already done it's work, and doesn't release the same amount of natural oxytocin just asnbsp;endorphins are affected when Pit is used. nbsp;Lower levels of oxy are made by the pituitary gland, and less of it finds its way into the CNS. The oxytocin receptors get desensitized. nbsp;Pit is also an antidiuretic, so administered with a full bolus, can lead to more engorgement than is typical in a new mom, making latching more difficult.All this combined puts a new mom behind the curveball, more so if she received Pit throughout labor with as little as 6 hours having a significant effect than in the last stages.If you would like to study references, I can look them up for you.nbsp;
I'm interested to see them if you have the info handy.

I'm also really interested in seeing the references.

ILoveRunning · February 2013

Celyn:
The one major con: Pitocin can inhibit the oxytocininduced milk ejection reflex and thusnbsp;impact breastfeeding.

I know this thread is kind of dead, but I would also like to point out that hemorrhaging or retained placenta can also affect breastfeeding. Something to consider when weighing the pros/cons.

tokenhoser · February 2013

Celyn:
LOL. Yes, I'm aware. Given that it's synthetic, it gets processed not entirely the same as natural oxytocin. Oxytocin plays in huge role in how much milk a mom will make. It binds to the oxytocin receptors in the mammory glands.
Intravenous Pit does not bind in the same way and intravenous dosing does not affect the brain in the same. To explain in a simple way, the body is a bit fooled into thinking it's already done it's work, and doesn't release the same amount of natural oxytocin (just as ?-endorphins are affected when Pit is used). Lower levels of oxy are made by the pituitary gland, and less of it finds its way into the CNS. The oxytocin receptors get desensitized. Pit is also an antidiuretic, so administered with a full bolus, can lead to more engorgement than is typical in a new mom, making latching more difficult.
All this combined puts a new mom behind the curveball, more so if she received Pit throughout labor (with as little as 6 hours having a significant effect) than in the last stages.
If you would like to study references, I can look them up for you.

I received mine intramuscular, though, which would be typical of a natural birth without IV. So no bolus, and a much smaller dose than an induction. I'd like the reference to really tease out whether it studied managed third stage labour or the effects of pitocin inductions on breastfeeding.

sschwege · February 2013

Both times I did not have Pit for the third stage. My hospital must not do it routinely because both times they never said anything about it. I didn't have an IV, so I know I would have noticed them giving me a shot in my thigh.

With my first birth the MW did use traction to deliver the placenta, with my second she did not (different MW). If it had been routine in my hospital, I would have probably agreed to it. But like I said, it wasn't even put on the table. In fact with my first birth they massaged my ute for what seemed like a long time and I told them that if they thought I needed Pit I was OK with it, and they said they didn't think I would need it.

Halen0804 · February 2013

The a-hole dr (not my regular dr) that was there for DD's delivery bullied me into getting pictocin after having it out in the middle of labor over my birth plan. In retrospect, it was not a big deal, but I wished I would have researched it prior to the birth. It's not what you want to deal with in the middle of labor. I"ll probably allow it again as it did not affect me or DD at all. I was able to BF her immediately and there were no complications.