Experienced Mamas tell me about delivering the placenta

[ExcitedMamma]

With DS after he was born and in my arms I did not notice anything else happening bc I was so focused on him. I completely missed DH cutting the cord and never even saw the placenta so I have no idea by what method it was delivered. This time I'm using a different OB and a different hospital. In my birth plan from my reading and planning for a natural birth last time I put in that I wanted to deliver the placenta naturally with no pitocin or pulling on the cord and that I would nurse to help release it. When I showed the plan to the OB today she said she likes to deliver the placenta within 30 min and that baby would be unlikely to nurse by then. What do you think? Should I be worried about artificial methods to deliver the placenta? Are these concerns overstated in natural birth books?

[queenmama]

My MW insisted on pitocin (didn't end up being a big deal since I had an emergency induction with it anyway) but I stood firm on cord traction.

Unfortunately, I wasn't able to nurse DD right away because of the circumstances of her birth. The whole "plan" really went out the window. :(

[swissair81]

This last birth, I had a great experience post-birth. I asked the OB (who I had never met before- btw. My OB was on vacation.) if we could leave the cord to pulse until the placenta was out. She said sure. The cord was pretty much dry before the placenta showed up, so we clamped and cut it. Once the cord was cut (courtesy of moi. That is one of my favorite parts- cutting the cord myself.), the OB told me to put the baby to breast to give myself some natural pitocin. I was surprised that she was okay with no artificial pitocin, given that I'm a grand-multipara. She only insisted that I have IV access, in case they needed it. It was never accessed once during my entire birth. The placenta came out with no cord pulling. In fact she didn't touch the cord until I was ready to push the placenta out. That said, none of these things are feasible if your care provider isn't okay with them.

[Dr C]

I really can't speak to the placenta--I really don't remember mine coming out!! But it is a red flag to me that your OB doesn't think your baby will be likely to nurse within 30 minutes. It is well known that babies put to breast immediately after birth tend to have better breastfeeding success than those who don't. Babies tend to be fairly awake during that time, and I know for both of my kids that immediate nursing session was much better than the ones that followed in the next 24 hours or so when baby is really sleepy. Yes, of course, there are times when there are legit reasons the baby can't nurse after delivery... but I would want an OB who sees those times as the exception rather than the rule.

[buddyleebaby]

All three of my babies nursed immediately after birth and the placenta expelled itself.

[brittone2]

I did not have pitocin afterward with DS1 (delivered by CNM at a hospital) or DD (FSBC birth attended by CNM). In both cases, I remember a few pushes and it eased out IIRC. Not a big deal at all. With DS2 (CNM attended HB), my MW did cord traction. I was not particularly thrilled at the time because it was very uncomfortable. I guess we hadn't hashed it out enough in the birth plan. She didn't really give me a chance to sort of push it out like I think I remember w/ DS1 and DD. It was different for me and I felt like there wasn't a need for so much urgency. She was doing the cord traction pretty quickly after the birth. No pitocin that time either.

DS1 and DS2 both nursed immediately after birth. DD looked around for a while but was probably nursing within a half hour as well.

[Katigre]

With DS after he was born and in my arms I did not notice anything else happening bc I was so focused on him. I completely missed DH cutting the cord and never even saw the placenta so I have no idea by what method it was delivered. This time I'm using a different OB and a different hospital. In my birth plan from my reading and planning for a natural birth last time I put in that I wanted to deliver the placenta naturally with no pitocin or pulling on the cord and that I would nurse to help release it. When I showed the plan to the OB today she said she likes to deliver the placenta within 30 min and that baby would be unlikely to nurse by then. What do you think? Should I be worried about artificial methods to deliver the placenta? Are these concerns overstated in natural birth books?
1. All three of my babies latched on within 30 minutes of birth - if your baby is placed skin-to-skin on you immediately after birth this really helps with them being able to do so.
2. None of their afterbirths required nursing to be delivered - my body delivered it on its own within 30 minutes of birth (actually it was probably just 10 minutes after birth that they were delivered - the last two were born at home and no pit was given, not sure if any was in my IV with DS's birth). Each time it just came down and the midwives said "Here is the placenta, gently push it out"
3. If you have an IV in place at birth I would be more concerned about artificial methods being used since sometimes it is second nature to put them in place at a hopsital.

[SnuggleBuggles]

1. All three of my babies latched on within 30 minutes of birth - if your baby is placed skin-to-skin on you immediately after birth this really helps with them being able to do so.
2. None of their afterbirths required nursing to be delivered - my body delivered it on its own within 30 minutes of birth (actually it was probably just 10 minutes after birth that they were delivered - the last two were born at home and no pit was given, not sure if any was in my IV with DS's birth). Each time it just came down and the midwives said "Here is the placenta, gently push it out"
3. If you have an IV in place at birth I would be more concerned about artificial methods being used since sometimes it is second nature to put them in place at a hopsital.

:yeahthat: Only 2 babies here and #1 I had pitocin as SOP (ticked me off but I had everything else I'd hoped for for the birth and decided to just roll with that one). #2 was at the birth center, we went skin to skin quickly, he did nurse soon after he was born and the placenta delivered fast and easy.o

eta- I didn't have an IV or hep lock so the pitcocin was given in a shot- a shot deep in my thigh muscle. One of the most painful parts of the whole day!

[123LuckyMom]

I really can't speak to the placenta--I really don't remember mine coming out!! But it is a red flag to me that your OB doesn't think your baby will be likely to nurse within 30 minutes. It is well known that babies put to breast immediately after birth tend to have better breastfeeding success than those who don't. Babies tend to be fairly awake during that time, and I know for both of my kids that immediate nursing session was much better than the ones that followed in the next 24 hours or so when baby is really sleepy. Yes, of course, there are times when there are legit reasons the baby can't nurse after delivery... but I would want an OB who sees those times as the exception rather than the rule.

This exactly! You should have a talk with your OB and insist that unless there are significant complications you have your baby skin to skin within minutes of being born. Push that baby out and squiggle it up to your chest. The nurses can clean the baby and do the APGAR after you've bonded and nursed. I feel so strongly about this that I even made them do this with DD after an unplanned c-section! I wasn't even stitched up yet, but my baby and I were skin to skin. I'd have a good talk with your OB. Make sure you'll get to nurse right after your baby is delivered. I have no advice about the placenta. Unfortunately both my deliveries were c-sections.

[PearlsMom]

Agree that it's troubling your OB thinks baby won't nurse right away. Baby may not, but many can and do. Our easiest nursing session in the hospital was that very first one. I ended up with an emergency-C, so no experience delivery of the placenta, but my OB was fine with letting it pulse before cutting, which took very little time as it was a pretty short cord.

[mctlaw]

I had an epi w/ my first, and had pitocin to augment labor, so it was probably flowing afterwards, as well. Not sure. I don't recall cord traction being given but in light of the epi not sure I would remember this. He had meconium so had to be suctioned and was not placed on my chest immediately becasue of this. He still latched on well under 30 minutes, though, IIRC.

With birth 2, I had no interventions, not even a heplock. No pitocin after either which my OB was supportive of. I didn't even think about cord traction since it wasn't on my radar from the first time around and they did this, which was a little uncomfortable and I told them to take it easy. It slipped out easily after a couple small tugs though.

Per my birth plan, DS 2 was gently toweled off and placed on my chest within a couple seconds while the cord pulsed for approximately 2 minutes. He latched on very well. So I also think its BS that this is your OB's experience - it strongly suggests he/she is not supportive of baby friendly nursing procedures.

[edurnemk]

DD was nursing 15 minutes after being born, so I disagree with your OB about it bring highly unlikely to nurse befor 30 minutes.

I really don't remember much about the afterbirth on both occasions, totally focused on baby. But this time they made me get pitocin, I was pretty mad but at 10 cm when this came up I wasn't up to arguing with anyone (my DR. Had agreed to hep lock only, but he wasn't there, this hospital has really lame policies). On my first birth I wasn't given pitocin, and I don't remember wether they pulled the cord or not.

[ExcitedMamma]

Thanks everyone! I am so annoyed with my OB! I purposely switched to a very natural and pro- BF Baby friendly hospital after hating the policies at my last hospital and this one makes it very clear that baby will be placed skin to skin with Mom for at least three hours for nursing and bonding after birth before any procedures are done. My OB said all the right things about my natural birth preferences when I first interviewed her but then she says things like this. Ugh...she's already made comments about talking to me soon about post dates when I'm not even forty weeks yet! All of this is not helping me trust her in regards to my other question I posted about when to go the hospital.

[almostmom]

I had natural births with both kids, and with my first, I believe he was with me and breastfeeding very soon, but the ob was concerned about bleeding and the placenta. Delivering it was very painful and I was given pitocin to do it I believe. I just trusted that it was the right thing to do to get it out, as it wasn't just coming out.

With DD, she also breastfed right away, but I don't remember what happened with the placenta. I may have gotten pitocin, but I honestly don't remember.

But both kids nursed right away.

[AnnieW625]

With DD1 I was already on pitocin to help augment labor and I had an epidural so I honestly have no if they turned the pitocin back on when I was delivering the placenta. It wasn't even on my radar. It just happened. I had been up for 28 hrs. by then so I was pretty tired. I was breast feeding within 15 minutes of having her.

With DD2 I had a natural delivery, but they did turn the pitocin on to deliver the placenta but I didn't feel it at all until after the placenta was out and I started feeling contractions and I asked the nurse what they was and they immediately turned the pitocin off. Again it wasn't really something that was on my radar so I didn't think the delivery of the placenta was that painful. Again with DD2 I was breastfeeding within 15 minutes of birth.

I was lucky to deliver at two hospitals, both of which encouraged skin to skin as soon as possible after birth.

[daisymommy]

All of my babies nursed right after being born, within 30 minutes. A woman's body does not need pitocin to or tugging and pulling to birth her own placenta (insert irked face!).
*Of course unless it's a special circumstance.


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[chillinoutmaxin]

Sorry she's not what you thought! Just remember that you can refuse anything you want to refuse.

I nurse my babies quickly. Two of them waited a bit for me to get out of the tub. My MW doesn't want the placenta delivered in the tub because she wants to catch it all and examine it (yuck!). It's all such a blur of excitement but what I think happens is that your nursing and the placenta will detach, you'll have some contractions and be able to push the placenta out. So they don't have to pull on it or give you any medicine. I do remember that it's scary for me each time because i feel the contractions and think of having a baby but it ends up not really hurting to get the placenta out.

[american_mama]

I do agree that an ob should know better than to say something like that, since getting a baby to nurse in that first 60 minutes is a big breastfeeding goal (see http://www.babyfriendlyusa.org/eng/10steps.html, Step 4, Help mothers initiate breastfeeding within one hour of birth).

But on the upside, I would say that ob's actually aren't too involved in getting the baby to nurse. I don't think it's their job. I distinctly remember the delivery nurse helping me get started breastfeeding my first baby, not my midwife who I think wasn't even in the room. I think the same thing happened with the other two as well.

So, I'd say make your breastfeeding wishes known to your husband or birth partner and your delivery nurse, and make your placenta wishes known to your ob since she is responsible for that part of the delivery.

As for the placenta, my take on it is that I think it's a gray area. I do think it is slightly overplayed in the natural birth community. I think it's probably better to leave the placenta alone to stop pulsing and ideally deliver on its own. But I don't think that quick cord clamping, pitocin use or mild cord traction are generally a big deal. Occasionally I hear about people that believe in "milking" the cord, others just in delayed clampin so even the procedure is a little murky. Delayed clamping might be worse in an ABO incompatibility situation, but you might not know you're facing that until a day or so after baby is born. Anything over gentle traction can snap the umbilical cord off the uterus too soon and cause severe bleeding, or even invert the uterus, so it all depends on how hard the traction is.

I just found it hard to get really solid info. about this and to really press my provider on it. I wasn't convinced of what was best, except that routine pitocin use seemed overboard to me. So I made that known and let the provider make their own call about the rest.

I had pitocin for the placenta once when I didn't expect it (midwife thought I was dehydrated and that it was a good idea), didn't have it once when I did expect it (it was standard operating procedure at that hospital, but they skipped it for me for some reason), and didn't have it and didn't expect it the third time. In each case, the way I delivered the placenta was the same (quick and easy). I don't think I ever nursed before the placenta came out (which was within 5-15 minutes each time, probably closer to 5), even though at least two of my babies nursed soon afterwards.

eta: I do agree your ob is not sounding too naturally-minded. If you want a natural birth, I think you might need to exert some effort with your OB. I'd write a birth plan, go over it with her AND your DH, give your DH some ideas on how he can advocate for you in the delivery room. I'd also go on a tour of the delivery floor (arrange it yourself if need be) and see how open the nurses are to natural birth and what resources the hospital has for low-intervention births (tubs in every room for laboring moms, 1:1 nursing support, birth balls, how familiar nurses are with all the different positions laboring moms get in, is food allowed for nursing moms, general attitude of the nurses). See if the nurses/hospital are more naturally minded than your ob, which hopefully will help. And if you think you need it, consider hiring a doula.