# Placental Delivery, Pitocin, and Keeping umbilical cord attached (research?)



## elanorh (Feb 1, 2006)

I think this is the place to post this, I'm hoping that I can get some helpful responses here.







This may be long, so bear with me ....









First - we've been considering keeping the umbilical chord attached for at least 1-3 hours after the birth of Baby #2. I read the article about it in Mothering last spring and it was fascinating and it sounds like it would be good to do. I don't think I want to keep the placenta attached longer than that .... Is there any medical research anyone can suggest for me to bring to the OB/MW to discuss this with him/her? (I don't know which I'll be seeing at my appointment next week) [My sister says she remembers learning about this in nursing school, that there are "trade-offs both ways," and she says she thinks that the rationale for not doing it has something to do with elevated bili levels and risks of jaundice? She is looking for more information and wants me to share with her anything I find too]

Second - The above sister, who is a nurse on a floor which deals with a lot of autoimmune and oncology patients, told me that we *really* should look into chord blood registries and save chord blood. I have always thought that chord blood banks were pretty much a scam to get parents to pay a ton of $$ for something they'll likely never need, and I know I've read of cases where the bank shut down and just left the blood unrefrigerated etc. etc. .... To me it seems that chord blood donation would be vastly preferable (although not possible in my area, I think the nearest hospital that does it is in Minnesota and I'm in WY!) .... Does anyone know much about the co$ts of chord blood banking, etc.? I'm assuming, if we leave the placenta attached for several hours, this question becomes a moot point anyway as the chord blood would be mostly transferred on into our baby.

Third - Does anyone know anything about using pitocin during or to facilitate placental delivery? The reason for this question is below - it's also something I'll be discussing with the OB.

I've been going through and filing/reorganizing our filing system and ran across the itemized bill for Ina's birth back in 2003 - I require an IV because of a heart condition which necessitates antibiotics during labor/delivery. Listed among the pharmaceuticals I received were 3 10u/ml doses of *pitocin.*

Now, this is bizarre - because I arrived at the hospital at 12:30 am already dilated to 5 1/2 cm. I was 8+ cm less than 1 1/2 hours later (my family labors fast







) - even though I was in back labor. And delivered at 4:30am. Obviously NOT induced, and frankly the nurses were in panic mode trying to get everything ready for baby's arrival once they realized that I really was delivering that quickly as a FTM. So what the







was the pitocin doing there on our bill?

So I talked to my mom, who told me it must be a clerical error (she's a nurse), and that they wouldn't have given me pitocin because with how quickly my labor was progressing they would have risked rupturing my uterus by giving it to me.

Called the doctor's office, she said there was no notation in my file and it sounded odd, but to check the hospital records as they are more detailed. The hospital said that the nurse's notes showed that pitocin was given during the time of *placental delivery* and that it's sometimes used to slow bleeding, or to make the placenta come more quickly.

_This does NOT jive with dh's and my recollections. We were NOT told they were using pitocin on me. I delivered the placenta almost immediately after Ina was born (the nurses were still doing their tests in the corner when it was delivered). And dh says there wasn't nearly as much blood as he expected (certainly not as much as there was during my m/c last fall). Plus, if I'd delivered the babe so quickly, why would anyone anticipate that the placenta would need pitocin?_

I then talked with my sister, also a nurse, who said that the nurse may have written the pitocin on the wrong chart - that it happens all the time. That some other mom may have required pitocin and not been charged for it, since it went on my chart.

Anyway, I'm going to talk to the OB directly about this and see what he says/recalls. One of the reasons I'm so incensed is that this is not the way our OB is, KWIM? He's pro-bf, pro-"extended" bf, he's very collaborative with his patients, great bed-side manner, he was absolutely OK with us wanting a NCB delivery, never even suggested meds prior to labor or during delivery. So if this really happened, I feel betrayed. But maybe, if it happened, it was more "hospital policy" than something he even knew was going on??

I wonder this, because now that I know more about the AAP bf policy, I know that the hospital policy for delivery was, as my sister the nurse says, "VERY old-fashioned!" - they placed Ina on my chest quickly to dry her off, cut the chord, then whisked her over to a table to weigh/Apgar etc. her, then dh was told he could go to the nursery with her for her first bath etc. -- I think it was at least 1 hour if not 1 1/2 hours after birth, before I was able to hold her in my arms and attempt nursing







... At the time, I didn't know that this wasn't "just the way things are done." I know better now, and have the AAP statement to bring to the OB appointment where we discuss labor plans, so the OB (or MW, whichever delivers) know what I want - and also plan to very politely let the hospital know that I'm sure they're following the AAP policy now, and expect that it will be followed with our baby's delivery.

My sister, whose first was delivered 10 years ago, said that she *never* was separated from her babies until they'd latched on and nursed, even with the baby who required a Ped to check her out when she was delivered. She had always assumed something had been "wrong" with Ina to require her to be separated from me so long, and aghast to hear that, no, there were NO concerns at ALL about her health when she delivered.

Thanks in advance for any/all suggestions, especially any articles you can refer me to!


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## pageta (Nov 17, 2003)

Regarding research, I would start here. No all of the links work, but the information is great.

Regarding the pitocin, did you have an IV at any point? That is generally how it is given. If you never had an IV, then you are probably right. Nurses notes aren't always correct - they are human and may have made the notes when the birth was over, not when it was happening.

You can request copies of your birth records and see how they recorded it there. The nurses notes in my records would show a time and what action was taken. If your baby was born at 9:36 a.m., it might say "9:38 started pitocin drip" or something about pitocin next to a time reference. There is a big flurry of activity so you may not remember it or the nurse may have remembered something that didn't happen.


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## elanorh (Feb 1, 2006)

Thanks so much for the link, I've printed off several articles to bring to the next appointment for our "discussion."









Based on what I read, it sounds to me like the pitocin was probably a "hospital protocol" thing, just "what they do" after baby is born -- the fact that I was hooked up to an IV for my antibiotics simply made it easy to facilitate but it sounds like a lot of hospitals give an injection to make the placenta come out quickly after birth. DH said that the nurses were all carrying around "checklists" that they were following to ready equipment etc., and I suppose it was probably just one of those things on the checklists.

But, it would definitely NOT be something they should do if we do a delayed clamping of the umbilical cord. If it were necessary, it should happen after the cord is emptied and clamped. And it looks like 1-3 minutes is a good 'timeframe' to wait for cord clamping, so that's not a long time anyway!

The only question I have after reading through the articles, is whether delayed clamping is safe/right for me and my child, given that I am an RH- mom. It sounded like there wasn't a lot of information out there about whether maternal antibodies would be transferred via the delayed cord time with the placenta. It doesn't make sense to me that it WOULD happen, since it's from the placenta (not, necessarily, from *me* KWIM?) .... But I'll have to see what information I can find. I might see about contacting Judith Mercer myself and see if she has found any information about RH factor with delayed cord clamping, that she can share with me/doc/midwife. [What little I read made it seem that the immediate clamping on RH babies might be considered to reduce *their* risk of RH factor complications, but that it's also tied to increased maternal risk of RH antibodies forming etc. But they do have (and give) a shot for that, anyway, KWIM?]

Regardless, even if we do immediate clamping due to RH concerns to baby in transfer -- from what I've read about the pitocin/"management" of placental delivery now - I am going to request no pitocin or other medical intervention management, other than nursing at breast, to facilitate placental delivery this time 'round unless there are concerns about me "bleeding out." Among other things that I noted, it seems that there are increased risks of retained placenta after the "managed" placental deliveries - and guess what? I had a small amount of retained placenta which was identified at 8 weeks pp and potentially contributed to my supply issues with Ina. So, whether that was caused by the pitocin or not, I do *not* want any again.

My sister cautioned me to be careful how I approach/word things with the hospital/docs etc. so that they don't become defensive - "Demand good care but don't be abrasive or accusatory." IF the pitocin is hospital policy, and they don't want to discontinue that for me, things could get rough. I labor so quickly I don't know if I could make it to the next-nearest hospital in time, potentially. And while in many ways, an at-home birth seems just fine to me, it freaks dh out and he'd rather have a professional there "just in case" (preferably a doc over a midwife even).

This has SO changed the way I feel about Ina's birth, and that makes me sad. It was a wonderful birth in so many ways - NCB, the nurse and doc were great (we thought at the time and I still think probably) -- we were really proud of ourselves and Ina too. I just feel blindsided that they would have done the pitocin without my knowledge/consent.

I really thought I was informed, but obviously I wasn't.









Thanks again - and for any further advice/comments/research anyone else has to share!


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## mezzaluna (Jun 8, 2004)

pitocin after delivery wasn't standard at my hospital, but when i continued bleeding after i delivered the placenta, they did administer pit through the iv i had for the antibiotics for GBS. i knew they were doing this #1 because they told me they were doing this, and #2 because those darn contractions came back!! it seemed so unfair when i'd just had my baby to suddenly get induced! ugh. anyway, it turned out to be internal tearing that the OB had missed, not anything to do with my uterus, so the pit was useless.

i'm surprised then, if you got pit postpartum, that you didn't feel contractions coming back???

we also want to delay cord clamping for baby #2.... we wanted to for #1 and asked to delay *cutting* the cord, but in the conventional mind of the OB that became clamp right away, then let the dad cut at his leisure.







but at least it meant my baby had to stay right on my belly for a while (until they started attacking me with local anesthetic, stitches, pitocin, etc.)


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## elanorh (Feb 1, 2006)

Thanks, Pageta, for the links. They were really helpful.

NP told me at our appointment that they seldom have requests for delayed clamping, but that she knows that they don't object to it and will certainly do as I want with that. And that, of course, pitocin shouldn't be involved 'til the placenta is delivered.

She didn't know about policy/expectations with pitocin during the fourth stage of labor, she said she doesn't think it's "policy," and that therefore there must have been a reason it was administered. So I definitely will need to talk to the doc about that. Maybe I WAS bleeding more than they wanted?? I know with my at-home m/c, I lost a ton of blood overnight and ended up going into the office and having a DNC to finish it off, bedrest, etc. etc. because I'd lost so much blood .... so maybe I was a PPH concern with Ina's birth too?? If so I'm not opposed to the pitocin - as long as I can do a delayed clamping.

Anyway, the articles I printed out are all filed in my file for OB/MW review before my next appointment, where I'll definitely see one of them to discuss more thoroughly.

Hospital says they follow mom's lead in re: bf and the AAP policy, but try to get all babies latched by 30 minutes after birth at the latest. They got a little defensive (I don't know why, I didn't even open my mouth, I just showed the AAP pdf I'd brought to the nurse and she started talking defensively about how supportive they are of bf). I just need to "tell the nurses what you want when you arrive."

So, thanks again for all the links/help!

And --- in terms of not feeling the pitocin --- birth is a pretty 'easy' event for the women in my family (my mom describes labor as "bad menstrual cramps," and I wondered whether that was accurate 'til I was in labor myself (back labor no less)) .... so I did feel continuing contractions but they were the same as they'd been before (much less powerful actually I thought in terms of pressure) .... not pain just pressure. So ...?? I don't know .... Definitely something to talk about with the OB though to get his perspective.


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## elanorh (Feb 1, 2006)

OK,

I spoke with the doc at my appointment today.

He said *delayed clamping* is fine with him, not a common request but that we can do that easily - wait for the cord to stop pulsing before clamping. No problem.

In terms of the *pitocin* - he said that it's "standard" and what's done. I guess he just assumed that I knew it was going to happen last time (I must admit I didn't research labor itself much with Ina - I talked to Mom/aunt/cousin/sister about NCB as they'd all had them, didn't read any books or anything







-- it went fine up to the point where they gave me pitocin without me knowing; I assumed "NCB" meant no interventions at any point unless medically necessary/requested by me; and I think he thought that pitocin wasn't a pain med and was medically necessary







) ....

Anyway, he said that obviously there shouldn't be any pitocin 'til after the umbilical cord quits pulsing and is clamped ... and that he will follow our lead in terms of when/if we do pitocin after that. He said we can put baby to breast and keep me warm and hopefully the placenta will deliver just fine with those measures .... But that if he sees signs of bleeding out etc. he'll need to administer the pitocin.

He said that his concern is a "hematoma" behind the placenta, and mom losing too much blood with the placental delivery. And that sometimes after delivery moms have a "lazy uterus" and forget to keep contracting, and that this "lazy uterus" is more likely with each subsequent pregnancy.

And, in terms of the retained placenta - he said that the research isn't conclusive in either direction (that pitocin prevents it or increases the risk) - and that sometimes the placenta grows into the uterine wall and pitocin woudln't do anything about that, and there's no way to know what caused the retained placenta last time.

He thought the pit levels were really high but as we talked through things he said - "Wait - your IV antibiotics weren't put in 'til right before you delivered, were they? So, you needed 3 units because there is a certain ratio of fluid : pitocin which needs to be met, and you needed that number of units because there was so much fluid in your IV."

SO .... I feel a lot better -- know what happened, and what should happen this time around and he was absolutely not defensive and very willing to listen and answer my questions. Not patronizing at all.

He DID say that "about half" of all babies he's seen put to breast after birth don't nurse right away - that often they are "just too tired or not interested yet" after birth, so not to be disappointed if that happened. I'm assuming that most of these "very tired/uninterested" babies were drugged up via mom's system during labor, OR the results of prolonged/difficult labor - neither of which I'm anticipating given NCB already with Ina and how quickly my family tends to deliver.


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