help me understand phase 3...

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waitingimpatiently614's picture
Joined: 02/17/09
Posts: 386
help me understand phase 3...

I have no recollection of delivering the placenta after the birth of DS1. I vaguely remember the OB saying it looked intact and healthy, but I don't remember if I had to push it out or what that stage was like. I guess I was just caught up in gazing at our new baby. I also don't remember if I was given any Pitocin? Is that the standard procedure? I am working on my birth plan for this upcoming birth, and I have noticed several sample birth plans state that they do not want Pitocin during/after placenta delivery. Can you help me understand the pros/cons to this? I have also seen several mentions of fundal that an alternative to the Pitocin, or something that is always done? Some birth plans state they do not want fundal massage or they want to do it themselves? Why would that be?

Also, I had an epidural with DS1, and this time I am planning an unmedicated birth with a midwife but I will be in a hospital setting. How will being unmedicated affect what phase 3 is like for me? Will I be able to just focus on immediate skin-to-skin with baby, or will I be having to focus on pushing out the placenta, still managing discomfort, etc.? I am just really confused. I have read several books, but I still do not know what to expect from this part of the delivery. Thanks for any insight you ladies can give me!

jolly11sd's picture
Joined: 02/02/05
Posts: 3327

My experience was similar to yours. I wasn't aware of delivering my placenta with DS2 and didn't have to push for it to come out.
It came out pretty fast after he did. I remember asking if he was delivering the placenta, as there was sudden discomfort down there, and the doctor said it had already happened and he was just sewing up my tear. I guess focusing on my new LO kept me from even noticing it happened. I was not given pitocin. The nurse did fundal massage (ouch) about 2 hours after delivery as my uterus wasn't shirking back down. Turns out that I just had a really full bladder that I couldn't release very well holding things up. She let me do the massage myself after a while and for some reason it was less painful when I did it so maybe that is why some women want to do it themselves. I don't really know how things can vary beyond my own experience. I assume it could take a while to deliver or be uncomfortable in some instances.

Marite13's picture
Joined: 08/07/09
Posts: 3368

I did not have any pitocin or any massage. I remember holding my DD and then all of a sudden, being like, "Whoah, wait, that hurts!" It was the placenta being delivered. I was surprised by the fact that it hurt, but it lasted all of a few seconds and then was over, and I was back to just paying attention to my daughter.

emansmom's picture
Joined: 03/24/09
Posts: 752

I had the same experience as Mara did. I was acutally nervous about the Placenta coming out and the fact that it might hurt. It turns out is hardly hurt at all and it came out within 10 minutes of the birth and just came on its own. Unless a mom is bleeding abnormally they do not need to give pitocin or do any uterine massaging (although it is standard for most OBs to do it regardless of bleeding). Breastfeeding is one of the BEST ways to help the uterus contract and bleeding to stop.

mandi04's picture
Joined: 08/10/03
Posts: 2272

I don't remember delivering the placenta with my first or second. With my third I remember them pushing on my belly as they delivered the placenta but that's about it. I had pitocin for my 3rd labor but don't recall if I got it after the birth or not. With my 4th I was completely med free, and didn't have an IV but after the placenta was out my midwife asked if she could do a shot of pitocin because I was bleeding a little more heavily than she liked and I okayed it. I do remember delivering my 3rd and 4th's placentas, and I actually had to push with those 2 births but I don't recall it being more than just a little uncomfortable

cactuswren's picture
Joined: 10/19/09
Posts: 4658

Wow, I'm jealous. I had to actively deliver my placenta, and it did take a couple of good strong pushing contractions to come out, but of course after what I'd just gone through and a distracting new baby in my arms, it was not that bad and over pretty quickly. I was just so mad that after successfully pushing out a baby I still had to do more work Smile (My labor was really long and I was just super exhausted by then--because of false labor the night before I actually went into labor, I'd been awake for about three days at that point!)

I did have a little massage but that first contraction was the only one I remember being bad. After that, it didn't hurt anymore. No pitocin or anything--I was in a birth center, so that wasn't even an option (unless something had not gone smoothly, of course--I do know a couple of ladies who birthed in the center but had to transfer to the hospital for phase 3 because of excessive bleeding or incomplete delivery of the placenta). Not to scare you, but really, just like birth it's different for everyone.

ETA: See, Erin proved me wrong--I guess pitocin was an option, but I just didn't need it.

TiggersMommy's picture
Joined: 02/14/10
Posts: 6043

I gave birth to DD in the tub then got up and carried her to the bed to work on getting her latched. My contractions had completely stopped. A minute later my MW said she was concerned about the amount blood in the water so she gave me a shot of pitocin. I was fine with that because DD was already out and I felt it was the least invasive way to encourage the placenta to move along. I still consider my birth to be med free. About 10 minutes later I felt the urge to push, bore down, and out it came. I don't think the pitocin even did anything because I only had that one contraction. I really don't remember it hurting but then again I'd just pushed out a baby and I was in blissful baby lala land. My MW inspected it, declared it intact, showed it to us, and then helped DH to cut the cord. I'm assuming she would have cut the cord sooner if she'd felt the amount of blood was still excessive. She later said that the extra blood was due to my tear and not anything to do with the placenta. The nurse did do some fundal massage. I remember not particularly liking it. She wasn't really aggressive about it though and when they left us she instructed me to massage every so often and to monitor the fundal size myself. All the placenta and stitching stuff that went down after DD arrived was like background noise to the high I was on from having just welcomed my baby. I can say that I didn't feel the need to actively manage any discomfort in the moments after she was out. I did use some of my relaxation techniques in the first week PP because I would have pretty strong contractions when she was nursing. Those were actually more intense than delivering the placenta because I didn't have those lovely birthy hormones.

ETA: I was at the same birth center as Leigh, which illustrates that every third stage is different. Our MWs don't have a standard protocol for administering pitocin. Some HCPs do. Ours do always have just a syringe full on hand just in case something like my situation pops up. I MUCH preferred a shot of pitocin in the leg to a transfer.

tink9702's picture
Joined: 09/28/08
Posts: 2977

with DS I had a shot of pitocin AFTER the placenta was delivered because I was bleeding excessively. My midwife recommended it and I agreed.
she also did massage. With DS I remember the contractions delivering the placenta being quite strong and painful.

With DD I don't remember it at all so they must have been easy! It's not just every woman, it's every birth that is different!

Lots-o-Tots's picture
Joined: 01/29/06
Posts: 574

I don't have clear memories of delivering the placentas in my hospital births, but I know that a lot of OBs are fans of - shoot, what's it called? When they actually yank on the cord to pull the placenta out? There's a term for it, and it escapes me at the moment. But I have a vague memory of that with at least one of my hospital births, and yes, the rather aggressive fundal massage. With my first home birth, I know the placenta came out on its own within 10-15 minutes of Lilah being born. I hemhoraged and my mw had to give me a shot of pitocin in my thigh, and then I delivered some fairly good sized clots shortly after that, and then eventually, I delivered the placenta on the toilet :/ With Finn, the birth itself did such a number on me . . . and I remember having to actively push the placenta out, and I was just so weak that it seemed to take every last ounce of energy I had. But that was an unusual scenario, delivering the placenta isn't usually a big deal.

cactuswren's picture
Joined: 10/19/09
Posts: 4658

"Lots-o-Tots" wrote:

I don't have clear memories of delivering the placentas in my hospital births, but I know that a lot of OBs are fans of - shoot, what's it called? When they actually yank on the cord to pull the placenta out? There's a term for it, and it escapes me at the moment..

Traction Smile

Not recommended!

Starryblue702's picture
Joined: 04/06/11
Posts: 5454

I too never paid any attention to the delivery of the placenta, because I was too busy with baby lol! But this time around I paid attention and even wanted to see it when it came out. It took about ten minutes to deliver it, and the OB said everything looked perfect and healthy. If you're having a hospital birth it's almost always their practice to administer pitocin into your IV (generally without your knowledge) immediately after delivery to speed up the process of the delivery of the placenta. There can be complications if it stays inside of you for more than thirty minutes after baby is born... it can cause hemmorage and many other things. I'm sure everything would be perfectly fine and it would come out on it's own most of the time, but this is just my OB's practice, so that's all of the knowledge that I have on the matter lol! My OB did massage my abdomen, and again this is just to get it to come out quickly... it doesn't hurt at all. I didn't have to push at all to expell the placenta, it just kind of slid right out. I got my skin to skin right away, but they took him to get his apgars and weigh him, so it was at that time that it came out, so I was able to pay attention.

waitingimpatiently614's picture
Joined: 02/17/09
Posts: 386

okay, this has all been really helpful. i will talk to my MW about it at my next appointment and find out what the MW group's standard practice is or what the hospital typically does so that i can figure out what needs to go in my birth plan. i would prefer that it come out on it's own, but i'm open to a shot of Pitocin and/or fundal massage if necessary. i am not planning to have an IV or heplock, so the Pit would have to be by injection. i am just relieved to know that in most cases, the momma can just be focused on baby and delivering the placenta isn't a huge ordeal. but it also helps to hear about those of you who had a different experience, so that i know what the possible scenarios are. the more information i have, the better prepared i feel. Smile