Placental Expelling Methods: Active or Physiological?
There are many different types of placenta removal procedures available today. They all have their pros and cons. Some of them are passive (cord traction) while others require some sort of physical effort to remove the placenta. There are also various types of placenta retention devices (PRDs). The combination of the type of placenta and the method of placental expulsion (or management) have a direct impact on your health care.
Research clearly shows that there are more benefits for the mother and fetus if the placenta is left in place for at least three minutes after birth. Serious complications may develop if the placenta is pulled out too quickly.
However, this is not always safe in real life situations.
In addition to the benefits for mother and baby, leaving the placenta in place may also prevent some medical complications. Physicians emphasize that there are many medical situations where immediate intervention is needed.
Some of these situations include:
A retained placenta after a vaginal birth may be a serious medical condition. Physicians don’t know the cause of this condition.
They believe that it may be caused by an unusually thick or sticky mucus plug that prevents the rest of the placenta from exiting the cervix. This can cause serious health concerns for the mother. Some of these concerns include severe blood loss, infection, and even death.
If the placenta doesn’t come out within 15 minutes of the baby’s arrival, a C-section is usually done to remove it. Some physicians may try to manually remove the placenta.
Others may attempt to manually remove the baby first and then remove the placenta. This is an uncommon condition. Physicians believe that it happens when a baby’s legs or arms get caught up in the cervical opening during delivery.
In some multiple births, the placenta may get fused together. This is known as a polystripe.
The multiple placentas may be very difficult to pull out. The physician may opt for a Cesarean section.
In some cases only part of the placenta may come out, while other parts stay inside. This is known as a retained placenta.
This condition is potentially dangerous to mother and baby. It may cause severe blood loss to the mother. If the mother has an excessive amount of bleeding, she may die. The retained placenta can also cause serious health concerns for the baby. The retained placenta can cause a serious infection that may be fatal.
How Is Active Management Of The Third Stage Of Labor Different From Physiological Placental Expulsion?
The best way to remove the placenta is with the use of fundal pressure. This causes the uterus to start contractions which speed up the placental delivery process. As the uterus contracts, the fundus is squeezed which helps to expel the placenta. This is the most natural way to expel the placenta and it doesn’t require any medical equipment.
The fundal pressure manual removal method involves the mother’s partner or an attending physician manually removing the placenta. This is a common technique used by most physicians.
However, in certain situations it may be too risky for the physician to attempt this method. In these situations, physicians may opt for a different removal method known as a fundal press.
In some situations, the physician may not be able to manually remove the placenta. This is especially true for first time mothers or elderly mothers.
In these situations, the physician may choose to use an instrument known as a fundal press. The fundal press involves placing an instrument on the mother’s abdomen. The instrument will then slowly release suction and apply pressure to the uterus over a period of time. This causes the uterine muscles to slowly contract which will cause the placenta to be expelled.
What Are The Dangers Of Quickly Removing The Placenta?
Physicians may be concerned about an excessive loss of blood after the birth. This excessive blood loss is known as postpartum hemorrhage. The physician may opt to use a fundal press immediately after birth. This will prevent excessive bleeding by manually stopping the bleeding.
The problem with this method is that it may increase the chances of tearing or damaging the cervix. This can cause increased pain during the postpartum recovery period.
In some cases a C-section may be necessary if the damage is severe enough.
The other risk is that there may be excessive bleeding after the birth even during a fundal press. This excessive bleeding can be dangerous for both the mother and the baby.
If this happens, the physician may have to immediately perform a C-section or other emergency procedure.
Is A Fundal Press Used To Treat Afterbirth Problems?
After the mother has given birth, the physician must remove the placenta. This is known as the third stage of labor. The most common way to remove the placenta is through fundal pressure. This involves applying pressure to the top of the mother’s uterus.
After doing this, the physician must continually check to see if the placenta has been delivered. If the placenta is still in the uterus, the physician will continue to apply pressure.
If the placenta is still not delivered after several minutes, the physician may have to perform a C-section to remove the placenta if it won’t come out on its own.
The benefit of a fundal press is that it helps to stop excessive bleeding during the placental delivery process. The downside is that it may cause damage to the mother or child.
Can A Physician Use A C-section To Remove The Placenta?
After the birth, what is known as the third stage of labor begins. The physician will then remove the placenta. The most common way to do this is through fundal pressure. However, some physicians may use a C-section to remove the placenta.
A C-section is a surgical procedure where the physician makes a incision in the mother’s abdomen. A surgical instrument is then used to pull the placenta out of the mother’s uterus.
This is a common way to remove the placenta from mothers who have had a C-section in a prior labor.
The benefit of this method is that it is less likely to cause bleeding complications. This is especially true for women who have had complicated labors or C-sections in the past.
The downside is that it is major surgery and does have its own complications.
Are There Risks Or Complications With A C-section?
A C-section carries more risks than a natural birth or fundal pressure. There is a small chance of infection, but this can be treated with antibiotics. There is also the risk of organ trauma or accidental cuts to other organs.
There is also a longer recovery process involved. It takes longer to heal from major surgery than it does with a natural birth or fundal pressure.
Should I Ask For A C-section If I’m Having Difficulties?
It is up to you whether or not you want to have a C-section. It is a major surgery with its own complications and recovery time. However, it may be necessary in some cases. If you are experiencing any complications or it is taking a long time for the placenta to be delivered, ask your physician about a C-section.
Do I Need A Lawyer?
If you believe that you or your child’s rights were violated during a fundal press during labor you may want to speak with a medical malpractice lawyer. A lawyer can help you determine if you have a case and what steps you should take next.
Sources & references used in this article:
- The Bristol third stage trial: active versus physiological management of third stage of labour. (WJ Prendiville, JE Harding, DR Elbourne… – British Medical …, 1988 – bmj.com)
- Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial (GQ Khan, IS John, S Wani, T Doherty… – American Journal of …, 1997 – Elsevier)
- Placental cord drainage after spontaneous vaginal delivery as part of the management of the third stage of labour (H Soltani, F Dickinson… – Cochrane Database of …, 2005 – cochranelibrary.com)
- The retained placenta (AD Weeks – Best practice & research Clinical obstetrics & …, 2008 – Elsevier)
- Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial (J Rogers, J Wood, R McCandlish, S Ayers, A Truesdale… – The Lancet, 1998 – Elsevier)
- Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage (D Leduc, V Senikas, AB Lalonde, C Ballerman… – Journal of obstetrics and …, 2009 – Elsevier)