Women’s choices – Natural vs Active Management of placenta

I have been faced with a dilemma over the past few days, and I feel compelled to write about my feelings to my readers. One of my clients who was then 38+ weeks had been cancelled at 38+ weeks from the centre where she really wanted to give birth (and where I recommended she go) due to her previous Post Partum Hemorrhoage (she feels this was as a result of very aggressive active management of her placenta). My client had disclosed all this information to the centre early in her pregnancy. Although we are unsure of exactly why the decision had changed from being accepted, to being cancelled (baby arrived before our meeting with the centres manager), there are a few fundamental concerns that I have about this situation.

One of my biggest concerns with this situation is that this woman felt vulnerable, isolated, and completely shattered that her hopes for a natural birth at the place of her choice had been taken away from her at such a late stage. My concern was that in her state of mind, she would now be more fearful of being pressured into having active management of the placenta (in the thought that this may prevent excessive bleeding. My client wanted to wait and see, allow for physiological pulsation of the cord to

cease at it’s own rate, of course accepting intervention at the earliest sign of potential for excessive blood loss). My fear was that her fear surrounding the above circumstances would lead to the production of protective stress hormones (Adrenaline and Cortisol) and that her risk of hemorrhage would actually increase!

As it turns out, baby arrived very quickly, without time to get to the hospital anyway. My first thought was of keeping the woman calm and warm, and thankfully she had a natural birth of baby and placenta with minimal blood loss and minimal stress.

I think the reason that rates of hemorrhoage are increasing in well healthy women is fundamentally because of the birth environment we create for women, new faces, fear of an unfamiliar environment, fear of medical procedures, so much so that a woman’s physiology changes, putting her at greater risk of hemorrhoage.

Some information from a Cochrane review can be found below;

http://summaries.cochrane.org/CD007412/delivering-the-placenta-with-active-expectant-or-mixed-management-in-the-third-stage-of-labour

Juliana

 

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