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In the case of an unassisted birth; reducing risk during 3rd stage

Last post 02-17-2010 8:41 AM by saoirse. 14 replies.
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  • 10-12-2009 3:52 AM

    In the case of an unassisted birth; reducing risk during 3rd stage

    [I moved this post from Midwife Chat since it really belongs over here. Smile Brlnbabies, Moderator]

    Fogive me if this post appears disjointed or illogical... I have wrote it a thousand times but it never seems to come out right. 

    I am currently 31 weeks pregnant with my fourth child. All my previous pregnancies, labours and births have been spontaneous, unassisted, normal vaginal deliveries. I have a very strong ethos of normal birth and strongly believe in evidence based care; midwifery led. 

    I find myself in new territory. 

    Background: I planned for a home birth for this pregnancy but cannot get a midwife due to my EDD falling over Christmas. My local unit is not able to provide me with evidence based care (15 min away from my home) but the unit several Counties away is by means of an MLU. The journey is 1.5hrs on country roads (Ireland). 

    My concern is that I labour quite fast. My births have pretty much halved as we have gone on; the third being 1.5 hrs in total - only about 40 min of which my husband and I were confident that I was in labour.

    I fear with these factors there is a strong argument to prepare for either a BBA or an unassisted birth at home. I am very confident in my body and my ability to give birth, however, have some worries in regards to the third stage.

    I would greatly appreciate any information or advice in regards to the 3rd stage of labour; minimising risk of bleeding, cord pulsating, when to clamp (what to clamp with even??) etc. 

    Thank you.

  • 10-13-2009 4:17 AM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

    Thank you for moving it , sorry..wasn't sure which was the correct forum!

  • 10-14-2009 1:23 PM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

     Dear Saoirse,

      I have been in your shoes, and did plan an unassisted delivery, rather than go to a hospital an hour away, with a hx of fast labors, and I'm glad I did!

    Most fast labors are not complicated, even most long labors are not complicated, until well-meaning, but misguided people start inter-fear-ing. This includes third stage difficulties as well.

       There is no need to cut the cord at birth.  It may stay intact as long as you wish. This practice is called "lotus birth".  However most people find it more convenient to cut the cord,than carry it around with the baby until it falls off (usually in 3 - 7 days) This is usually one of the last things I do. I never cut the cord before the baby is breathing well & placenta has devilered. To cut it, you can boil (for at least 10 minutes) a pair of scissors and a shoelace, bias tape or two hair barrettes or sturdy bobby pins. Or you can buy a cord ring or clamps (from "In His Hands Birth Supply", and probably other birth suppliers too) About two or so inches from the baby, clamp or tie cord off in two places, close enough together that you can just get the scissors in between to cut the cord.

    If cord is tightly around neck, keep the baby's head close to whichever of the moms thighes it is facing, bringing the body & legs around, so it somersaults out. This keeps the baby form strangling on a tight cord, as the further from the perineum the baby's head gets, the tighter the cord pulls around the neck.

    If baby comes out limp and white, lower the baby down lower than the placenta, so the baby will get more blood from it (this is a good reason not to cut the cord to soon!) You should see the baby pink up and start to breathe in just a minute or two! If not, put the baby over your arm and start mouth to mouth & nose resuscitation, remembering how small the baby's lungs are at this point... they can hold about as much as you hold in your cheeks with a normal breath, so don't blow too hard! This is usually enough to get the baby to start up  its breathing.  

    Start nursing the baby as soon as it is born, this will help the placenta come & decrease your bleeding. BTW, not smoking & eating lots of green leafy veges prenatally will avoid a lot of blood loss!

    During pregnancy, your blood volume expands, so you can afford to lose some blood after birth without any untoward effects, but if you lose so much blood that you feel woozy or faint, have your husband slice off a little piece of the placenta, and put in between your teech & your cheek (like a plug of tobacco) The oxytocin in the placenta will be absorbed by your mucus membranes, and should stop the hemorrhage in short order.



  • 10-15-2009 1:36 PM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage


    thank you so much for your reply - really appreciate the time and detail you have gone through!


    As I said, I am not worried about the birth but more the after .... your advice in the case of  bleeds is great, thank you!

  • 10-30-2009 5:08 PM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage


     love your reply

  • 11-12-2009 8:23 AM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

    Well, on monday (34+ wks) I was diagnosed with grade 2 placenta previa - placenta is not covering the os nor is it in the path of the presenting part (head) but is only 1cm from os. Not looking good. 


    I have been instructed to come in with any signs of bleeding and will be kept in more than likely. They are talking scheduled surgery for the baby at 38wks.

  • 11-16-2009 8:46 AM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

     Oh saoirse, i'm so sorry :(  That is so so different from the birth you were anticipating. 

    Did they feel there was still time for movement?  I have at least one friend who went from a grade 2 to a grade 1 in the last 6 weeks and managed a vaginal birth with somewhat heavy bloodloss (there was some separation during dilation) but ultimately with both her and babe in good condition.

    My brother's birth was an emergancy section due to compete praevia andultimately the surgery DID save both his and my mother's life.

    Many (((((hugs))))) to you while you process this information. 


    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 11-26-2009 10:02 AM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

    It moved! There is now 4.5cm in the difference of measurements so I am not even considered low lying placenta! We are so very thrilled!

  • 11-27-2009 2:10 AM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

    It moved 3.5cm in 2 weeks!?  Wow, i did not know that was possible so late on.  I'm so so happy for you saoirse! Smile  This is such great news.  So what are your plans now - will you hit the road with your first twinges or remain at home?  Either way i cannot wait to ead your birth story! Smile

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 12-21-2009 3:02 PM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

    we don't think it is possible..being called misdiagnosis!


    Just a quick update... baby girl was born yesterday, Dec 20th at 39 wks. All went perfect, spontaneous natural vaginal birth. We decided to go into the unit in the end - walked in at 9cm and gave birth standing. We are thrilled! Home since this afternoon and loved up in bed.



  • 12-21-2009 5:21 PM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

    Congratulations and happy Birthday! Yes Cake Party!!! Paradise


    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 12-22-2009 9:12 AM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

    Blessings to you and your whole family, Saoirse.

    When your babymoon is over we'd love to hear your birth story.

    I think it's important for women to hear good positive birth stories especially when fear and misdiagnosis have intruded on a pregnancy and a mamababybody works to perfection in spite of that.

    Good Job!


    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 01-19-2010 9:50 AM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

     Just joined the forum today. Amazing story. I am so glad everything worked out so well in the end!!

    Kathleen Baca
  • 01-20-2010 9:16 AM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

     Kathleen, I just sent you an email.


    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 02-17-2010 8:41 AM In reply to

    Re: In the case of an unassisted birth; reducing risk during 3rd stage

    Sorry, I haven't been able to log in until today and then had password problems.

    I would love to share my story. It will be long. In order to understand it all I suppose it needs going back.  All in all it ended up a good experience but it involved alot of fighting and some really not nice bits.

    I suppose it starts with the fact that I am in Ireland. My username, Saoirse, is the Irish word for 'freedom'. I think that is a very relevant point to make in order to understand where I was coming from when first joining this site and writing the first post.

    All I ever wanted was a homebirth for this baby. I am very well informed in regards to birth and I felt that midwife led care was the only option for me and my baby. I had given birth in the local CLU before and felt that doing so again would put us both at risk due to their routine policies and medicalised midwives. (I was lucky, despite being in the CLU I had spontaneous unassisted vaginal births but I was severely over managed duing a 3rd stage of labour on one pregnancy and it had played in my mind since. This local CLU has a section rate of 50% some days...) As my edd was so close to Christmas no independent midwife would take me. I was devastated. I then decided to go to the local MLU but despite having had 3 previous spontaneous vaginal births and deemed a perfect candidate/lowest of the low risk they wouldn't take me as my BMI was off their exclusion criteria by 7 pounds. Yes, 7 pounds. I knew I was overweight as I had put on 2st following a miscarriage but I am very active and very healthy. So, I lied. And went to an MLU 1.5hrs away from me to get the MLU scheme. Luckily when booking in the midwife simply asked me my which I lied about in order to get in.

    So, this brings us up to my first post on here. About going to a unit 1.5 hrs away and being worried about not making the unit. I was secretly hopoing I may not make it, tbh but I also really feared birthing in the car as the roads are very poor Irish Country roads (anyone who has been here will know all about that!). My husband is also not trusting of birth as I am - an unassisted delivery would really shake him. So, this was my situation...not really sure what was going to happen or where but preparing for all options.


    My pregnancy was brilliant. I remained very active and was determined to eat only healthy food. With the help of a midwife at the MLU I ate only nutritionally rich foods and between that and the active lifestyle I only put on about 10lbs by 30 wks of pregnancy. My baby was growing well, even measuring big, and I felt amazing; the best I had in a pregnancy so far!

    At 34 wks I was sent for a routine scan to determine the position of the placenta as it had been somewhat low at 12 weeks. At the scan the radiologist mentioned that it was a bit low but would probably be fine..she called in a doctor for a second opinion and the doctor signed it off and I was back in the MLU. I drove the 1.5hrs home and just as I was entering our village I got a call asking me to come back. The radiologist was somewhat unhappy with the first scan and it being signed off and I was asked to come in for a second scan so a 'specialist' could see it. I drove back to the unit  and the radiologist performed the scan abdominally. The specialist came in and they spent the next while talking to themselves. I asked them what they saw, what the problem was - and they continued to talk between themselves. So much for keeping me part of the decision process. Finally they did a trans-vaginal scan and again went back and forth with each other as to if it was considered low lying or placenta previa. Finally, this specialist simply says "give it grade 2" and I was told that my placenta was 1cm from the os and that I would be discharged from the MLU immediately to a consultant team to discuss a ceasarean section.

    As the unit was so far from our village and as we assumed it was to be a surgical birth was transferred units to my more local unit (the one that had the issue with my weight) and I met with the consultant the following day. We learned that the local unit had a CDiff outbreak - so I had to attend this meeting alone without my husband or doula.

    I attended the meeting and was told that I could expect to bleed heavily at any time. If I bled heavily I was to come straight into the unit - if they could stop the bleeding I would be admitted until 38wks. If they couldn't stop the bleeding I would have emergency section. I was told it was highly likely I would bleed. I was given a section date for the 10th of Dec and was told I would not have another scan (depite this obs not even having a copy of the scan report from the first unit). I cried the whole meeting and felt so down.

    I came home and started doing research - asked on here about trial of labour with a grade 2. I was encouraged that in the US and UK it seemed that as long as the placenta was not covering the os that vaginal birth was possible. I was hoping that I may find a doctor in Dublin who might give me a trial of labour. In my reading/research I discovered that most women with grade 2 placenta previa have had some form of spotting or bleeding in their pregnancy by 30+ weeks. I was 34 wks and baby measuring 35 weeks. I had no bleeding/spotting/cramping at all during my pregnancy - despite being very active.

    So, I decided to go for a second independent opinion in Dublin.

    I was recommended an obs who is very open-minded and mother-friendly from AIMS Ireland and my Doula.

    I booked in to have a scan with him and his team in a few days time - it was exactly a week from the first scan at the first unit.

    I went in for the scan and met with the obs. His radiographer did an abdominal scan and said she couldn't see any problem with the placenta. She then called another radiographer in and they did a trans-vaginal scan. They spent nearly an hour scanning and discussing the measurements with themselves, the obs, and my husband and I. Finally, we were told that at the lowest point the placenta was 3.5cm from the ob (not the 1cm in the first scan) and that the majority of the placenta was at least 4.5cm from the os. They wouldn't even consider me low lying placenta let alone a previa. The obs told us this is not the first time they have seen a misdiagnosis like this from the unit in question.

    So, we were thrilled and after discussing it decided to book in with this Dublin unit under the new obs as midwife led was now totally out of the question. My pregnancy ticked along nicely and I discussed my birthing preferences with the new obs and midwife team. My main preferences were spontaneous labour (discuss induction after 14 days post date), no accellerants, no pain meds, no ARM, stay upright, birth upright (preference of standing) and physiological 3rd stage - cord finish pulsating. He was fine with all of it and the birth plan was signed off as a contract.

    Unfortunatley, the labour proved to be as dramatic as the pregnancy!

    I had been having show for about a week (38wks) and the thurday it became quite heavy. I was sure on the friday night I was starting and went for some reflexology. After the reflexology I had a long bath in which everything settled down again. I woke on the Sat with a ton of energy and we had a lovely day - went to see Santa, had lunch out with the kids, etc. Its funny to think back as getting the kids to meet Santa was the last thing on my 'list' that I wanted to get done before the baby arrived!!

    Sat night I started getting alot of pressure in my back- around the coccyx - this was a new sensation for me and it was quite intense. We went to bed as normal Sat night but I was never really comfortable. I woke around 4:30 with my husband snoring so went downstairs, put on the dishwasher, put all the Christmas lights on, the radio on, did a few chores, went online ect. Was feeling pretty good bar the pressure in my coccyx and then around 5:30 got a bit of a sore back and then had 2 quite strong contractions a few minutes apart. Had a shower and they kept up...very close. So woke my husband and he said they were about 4/5 min apart. I saw a light on next door so neighbor's hubby came over and we headed to Dublin as last labour was very quick (1.5hrs from first twinge to birth).

    I was still having surges but in the car they became more spaced...every 10 min and other than pressure in my backside felt they had eased in strength. We were listening to Jane's Addiction's "Jane Says" over and was the only thing that had the rhythem I liked! Got to Dublin and the new unit and went to labour ward. My obs was away and when the Midwife went over my birthplan and she started saying "No" to nearly everything on it!  She started saying that from late stages of labour that I would not be allowed to have any part of me on the floor - that I had to give birth on the bed and could not stand. She also said that should my waters j"ust happen to break" during a VE that it could not be helped.This was another huge issue for me as on my first I was given an ARM with an OP baby and it was sheer Hell - so very against ARM. It was at this point that my labour completely stalled.

    I consented to a VE; She checked me and I was fully effaced but only 2cm - head still high - and as contractions had stopped I was considered not in labour. I told my husband I wanted to go home and that I wasn't coming back. I asked her to give me my chart with full intentions of not coming back.

    We drove the hour from Dublin back home and the second I walked in the door the surges started back up again; just twinges and faint. It was about 9am. They were about 10 min apart and very mild.. so I got in the bath and fell asleep in the bath listening to my hypnobirthing cd.

    I got out of the bath and came was about 9:45 and my husband was making breakfast and quite suddenly the surges started fast and furious...they were about 90 seconds apart and I felt terrible pressure and pain in my coccyx. They were not letting up and I could feel the waters bulging but could tell her head was still quite high. I was standing at the kitchen table and would stand for the surge and then as it was over would go to sit for a second but never got the chance as another was starting back up.

    We debated going into hospital or staying at home for an unplanned homebirth. I really didn't want to go into the local unit as the last contact I'd had with them was when they refused to give me a second scan. As far as they were concerned I should be a section. I wanted to hold on and stay home but at the same time I was finding things very difficult - it was the most painful sensations I'd ever had in any of my labours and while I had bad pressure I didn't feel her head got bit nervous as something didn't feel right. My husband was very nervous and eventually I decided it was best to go into the unit.

    We ran to the car - it was Ireland's first snowfall of the year so the roads were really snowy and icy - I only realised when we were halfway there that I was barefoot and without a coat!! We had also forgot our labour bag. We slid all the way from our village to the hospital.

    I was brought straight to delivery at 10:30am and was 9cm, waters intact. I was met by the midwife who told me that as they had no record of me they needed a baseline of the baby - so against my better judgement I consented to a CTG for 20 minutes. Being tied to the bed was horrendous - the pain in my coccyx was so immense. The waters went while the midwives were taking notes but I still had tremendous pressure - but no urge to push.

    The next hour was horrendous...I had a desperate midwife who wouldn't take off the CTG despite the 20 min trace being up. I could not get comfortable and all I wanted was to get up standing. She kept trying to get me to push despite not being fully dilated or having the urge. She then mentioned Oxytocin (!) at 11:30am to try to speed things up as the contractions had become less frequent. FFS, I was only in labour 2hrs and in the hospital an hour! I told her "NO WAY" and my husband again said that it had been ages and to get the CTG off me and let me off the bed. We finally got quite aggressive - started taking the CTG off ourselves and told her it was coming off and that I wanted off the bed.

    A new midwife was assigned to me at this point and I spent the next while standing at the side of the bed - this got the contractions back up to less than every minute nearly instantly.

    It was very tough going. The new midwife explained I had a rigid anterior lip on the cervix which the head was caught on - so the baby stayed high. I also had a ton of waters...every contraction brought a gush of water and I would immediately get a small bit of relief.  The second midwife was great - brought in a radio, gave my husband a massager for my back, and was hands off supporting me while I stood by the bed. She asked me was I happy to give birth standing as she thought it was close - I told her that had always been my preference.

    Finally, after about 2 hrs of being in the hospital, I got a huge gush of water with a contraction, felt the head slip down and got a strong urge to push - with one push my beautiful girl  was born while I stood by the bed at 12:30pm.  I had no tears or stitches and had immediate skin to skin as she fed for the first time. She had a mark on her head from where she was caught on the cervix, poor pet. She weighed 8lb 10oz and was 21 inches - born on Dec 20th at 39+2 gestation

    It was a really tough birth - my hardest yet.  I cannot believe I had a 2hr transition; my others were very fast from 5cm. All in all, it was still relatively short - about an hour at home and 2 in the hospital but it really took alot out of me. I am also quite upset still about the first midwife...but my God was the second brilliant! I would love to know what the pain in the coccyx was from - 8 weeks on and I still have pain there.

    8 Weeks on and we are all doing great - she is a brilliant breastfeeder and we are all totally in love with her.

    I have formally requested all my birth notes and the scan reports through Freedom of Information Act - I will make a formal complaint about the scan/placenta previa. I have also put in complaints to the Dublin hospital regarding my experience and the local unit regarding the first midwife.

    So...that is our story. Nothing like what we planned. Parts of it horrific. Parts of it a brilliant experience. Too much of it spent fighting.

    Here's to women-centred care and mother-friendly birth practices becoming more of a reality in Ireland in the future. If anyone is interested, AIMS Ireland (Association for Improvemetns in the Maternity Services - Ireland) are a great Irish birth related organisation who are working hard to change things for women in Ireland. They have been a great support to me.

    Thanks again for all the advice and support!

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