[lisamct]

Originally Posted by RNnL&D

And to lisamct, you say most women choose to have an actively managed third stage. Are they really choosing that or is that just pretty routine and they accept it? What I mean is, many of our docs routinely give Pit after delivery and most women have no idea of it ahead of time, so they don't think to ask whether they should have it or not. It is just a few that come in asking for no Pit after delivery.

Your right, to most women an actively managed 3rd stage is more of 'routine' than an actual choice that women make in most cases. IMO my unit is particularly bad at offering choice to women in 3rd stage, so far in that it actually classes use of 3rd stage Syntocinon as 'normal'. It would only pass over into the 'abnormal' if IV Synto was used also.
Informed choice is a big issue here as Im sure it is everywhere but choice in 3rd stage management seems to be lagging far behind where I work. As a student I spend a lot of time alone with women during their labour and we discuss issues such as pain relief and 3rd stage. Most of the women have never even heard that they have options in how they manage 3rd stage and expect to get "the wee injection in your leg that helps the placenta come out". Ive offered women info on their options but often find that any info Ive given is over-ridden by qualified midwives horror stories of extreme PPH's.
Just to illustrate the point, during my last placement I supported a women who explained from the start that, if possible, she wanted a Physiological 3rd stage. We took over her care after both the senior midwife and SHO had failed to convince her that it was a bad idea (we werent present at these discussions but from the womens description they were less than supportive of her choice!) My mentor explained that this was the 1st physiological 3rd stage she had been witness to in the 8 years she's worked in our unit. After both baby and placenta were delivered she did bleed, enough that my mentor felt it necessary to administer IM Synto (she had explained beforehand that this situation might occur) but, I wonder if it was more her inexpereince of physiological 3rd stages that led to her panicking about blood loss that was actually normal for the situation.

'Belinda-wales' your right I did forget to mention waiting for signs of seperation. 3rd stage management, in particular CCT, is one of my main stressors I guess im just as twitchy writting about it as I am doing it!!

Sorry to have waffled on a bit!!!

[hf82rn]

Originally Posted by beckinben

And I second meghan - PR cytotec works great. No IV needed.

What dose of cytotec do you administer rectally?

100% of our moms have IV's. In fact, even when we get a precip, starting an IV is at the top of our list along with EFM, prenatal history and SVE. We always administer 10units of pit IVP, or if there's a bag of LR hanging with 10units pit when turn it up after delivery of the placenta. Sometimes if the OB/GYN thinks mom is going to bleed (i.e. PPH history) then he'll have us administer the pit after the shoulders are delivered. It is amazing how fast the placenta comes out after that.

I would love to get away from our 100% IV rate, especially for the mom's (like me) who long for a "natural delivery". But working at a small private hospital with 20 births per month, it is unlikely to be an easy change.

[beckinben]

Originally Posted by hf82rn

What dose of cytotec do you administer rectally?

800 mcg

I had a precipitous birth with my second baby. There was no way anyone had time to get an IV in me. Not really much of a priority when the baby's half out, in my opinion...

Becki