postpartum hemorrhage

Retained Placenta, what you need to know

After a baby is born, the placenta, which transferred nutrients and oxygen to him, and go rid of waste, is ready to be delivered. Ocassionally, a placenta follows on the heels of the baby, and rarely, it can take as long as an hour or more to release from the uterine wall and pass through the vagina, but most of the time it is delivered within 5-20 minutes of the birth.

As long as the placenta is fully attatched to the uterine wall until it releases and is delivered, it is safe to wait patiently. If it has partially detached, the wound left on the uterus is now able to bleed freely, since the uterus can’t contract to stop the bleeding if the placenta is still in its way.

Research generally shows the safety of “expectant management”, as long as postpartum bleeding is normal. If bleeding increases and the placenta does not present itself at the perineum immediately, “active management” of the 3rd stage becomes necessary for the mother’s safety.

Active management involves adminstration of pitocin, a medication given by injection or through an IV that forces the uterus to contract. This is combined with controlled cord traction where the doctor or midwife gently pulls the umbilical cord to encourage the placenta to deliver.

Most of the time, a combination of these methods do the trick. If the placenta still does not detach and bleeding is abnormal, a few women will need a manual extraction of the placenta, where a doctor inserts his hand into the uterus and attempts to remove the placenta by “scooping” it off the uterine wall. This is a very painful procedure, but when faced with extreme blood loss it is obviously preferable.

The last resort for a normal, but very stuck, placenta is a D&C or D&E, which works, but since it carries surgical risks it is usually the last choice for placenta removal. A placenta that is adhered into the uterine wall, such as through a cesarean scar, may require a hysterectomy to be removed.

To tell you about all the emergency situations makes it sound like retained placentas are more common than they are, but even though it only affects a small number of women, it is helpful to understand the basics so that if it does happen to you, you will know what to expect.

Now that I’ve shared the chain of events, here are some tricks of the trade used by care providers to prevent retained placenta and encourage its delivery as quickly as possible:

  • A liquid iron supplement during pregnancy reduces blood loss postpartum, as well as the effects of blood loss. Nature’s Sunshine and Floradix are highly effective.
  • Preterm birth is more likely to end in retained placenta because the body doesn’t think it needs to let go of it yet. Use appropriate workload and nutrition guidelines to prevent preterm labor.
  • Avoid induction, especially prior to 40 weeks, unless medically necessary. This creates the same scenario where the woman’s body doesn’t anticipate the birth and has a hard time letting go of the placenta.
  • If mom feels unsafe during or after birth, oxytocin release (necessary for contractions) will be blocked off by adrenaline, preventing delivery of the placenta. Make sure you feel safe in your birth environment, and address any fears you have as they surface.
  • Delayed cord clamping reduces maternal blood loss, and possibly partial placental detachment. See www.cordclamping.com
  • Blue Cohash and Shepherd’s Purse are herbs used by some midwives to encourage uterine contractions to reduce bleeding and expel the placenta.
  • The smell of ammonia has been found to induce contractions postpartum to delivery sticky placentas.
  • Skin-to-skin contact with baby and breastfeeding or nipple stimulation releases oxytocin.
  • Gravity friendly positions to assist with delivery of the placenta, unless bleeding is heavy.
  • One old trick is to blow hard into a narrow-necked bottle. The pressure exerted may encourage placental delivery.
  • Sounds funny, but some say induced sneezing via pepper can work.
  • If bleeding is normal, sit on a bedpan and bend your body forward. This can induce the urge to push out the placenta, especially when your stomach muscles are tired from labor and you don’t feel like pushing anymore.

Does anyone else have ideas that worked for them?

Something to Think About #22 – Preventing Postpartum Hemorrhage

Came across this note by a midwife somewhere, perhaps Midwifery Today, or a yahoo group for midwives I’m a part of. Thought it might be useful for those who have had a postpartum hemorrhage before.

Utrophine is a uterine glandular developed to feed the uterus. When I have moms with babies close together, or a previously sluggish labor, I have them take it through the next pregnancy. Don’t know if it’s coincidental, but the next labor goes well and I’ve not seen a PPH.

Here’s another one from Midwifery Today’s E-News 11:19 regarding prolapsed uterus and postpartum hemorrhage.

I have found that Utrophin PMG and Ligaplex II, both Standard Process products, work very well for restoring the uterus after prolapse. I have a mother whose uterus prolapsed, actually coming inside out with severe hemorrhaging after her 11th birth. We used the two products (after resting the uterus for over a year between pregnancies) and her 12th and 13th births have been wonderful. She also was able to carry the babies much higher, whereas before she had carried them very low for at least three months before delivery.

Here is an article by a company who sells Utrophin PMG, along with more information about this supplement can protect your uterus. If you are interested in purchasing some for yourself, I think you will need a referral from a healthcare professional who has an account with Standard Process, which you can find through their website, or you may able to find some elsewhere by googling Utrophin PMG.