How long to wait for Madame Placenta??

Specialties Ob/Gyn

Published

Just wondering how long your docs/midwives allow for the placenta to deliver...

...attended a staff mtg yesterday & found that our staff wants her out in 3-5 minutes! They of course help her out by hanging Pit & PULLING! :angryfire :trout:

No freaking wonder we have so many PPHs for retained frags/membranes! And I'm surprised we don't have more inversions.

I think this is ridiculous. What do your facilities do?

(I did of course bring up that the Pit would probably not be necessary if healthy babes were put to mom's breast immediately...preaching to the choir....)

Specializes in L & D.

Take it from someone who went through it, manual extraction without pain meds is hell. Mine happened 6 hours after our first daughter was born, because I was hemorrhaging. Yes - it probably saved my life, but it took a long time before I would even discuss having another baby!

Up Vote Up Vote ×
Take it from someone who went through it, manual extraction without pain meds is hell. Mine happened 6 hours after our first daughter was born, because I was hemorrhaging. Yes - it probably saved my life, but it took a long time before I would even discuss having another baby!

Me too! I swear they had 10 people holding me down on the table. There is no way to describe the agony!

Up Vote Up Vote ×
Specializes in nursery, L and D.

Hey Arwen, my SIL delivered at your hospital last year and doc pulled cord off placenta while doing traction. Didn't pre-medicate before extraction. Actually, he couldn't do the extraction and had to call someone else. I thought my poor SIL was going to bleed out before they got the darn thing out. Thank Goodness her epidural was about half way working. Our docs do the pit and pull, too. 5 min. tops allowed with most docs. I have seen lots of manual extractions. I had a manual extractions with absolutely no pain meds with my dd 3 years ago (at my hospital), I would rather have 10 more labor and deliveries than 1 more manual extraction. To top it all off, my doc yells at me (as I am crying out in pain) "WELL, I HAVE TO GET IT OUT"...........needless to say I don't see that doc anymore. So, I wonder if it is just in this area?

Up Vote Up Vote ×

It usually takes no more than 15 to 20 minutes. Our docs will gently tug - nothing forceful.

steph

Up Vote Up Vote ×
Specializes in L&D, PACU.
I did, & then for good measure Dr Ogre stuck in a 10" hemostat with guaze and swept it around her uterus "to make sure he got everything". Barbaric is right!

Could a nurse do something (report the ob?) in a case like that?

Saw something similar. She was given pain meds but they didn't seem to be touching her...it was horrible

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Those witnessing barbaric procedures involving pain for no reason like this should be writing up occurence reports. HORRIBLE.

Up Vote Up Vote ×

I tried to get the mom to file a complaint. I thought after some time went by she would. She is quite clear on what happened, but didn't. I did write it up from my point of view and I still have it. I'm not sure where to send it. I'm very tempted to send it to the medical board.

I was very powerless in this situation.

Let face it, I was the doula that brought the client in pushing :rolleyes: (by the clients own choice, because she was sick of her dr's "stuff" I think.) The baby came out 10 min after we got there. he didn't have time to do the episiotomy and was angry about that. (he'd been telling her for weeks if she didn't have one she'd have a fistula..) I didn't see any bleeding and at the time It happened I was so SHOCKED I gave the look to the nurse, the dad, the dr. and let mom crush my hand. NO one said anything but the one nurse said 'she's just asking for a minute" It became instantly clear if I said anything the doc would take it out on my client. he did bring out the lidocaine to stitch her tiny tear, so I think it could've been worse...

This dr was so horrid I swore off him and that whole facility. I refuse to go there again and I do tell moms why. I do wish i had tracked down that nurse. I've come up with other blunt /track stopping sentences to say in a similar case, and I will consider physical action if I should ever see another horror like this. I'm no hot head either, but the consequences of not stopping this does weigh heavily on me.

I hope as a nurse I'd have more power.

Up Vote Up Vote ×
my daughters doc didnt wait. once baby was out she pulled on the cord and the cord broke. so guess what, she went in up to her elbow, no lie, i was standing right there and manually extracted it. no pain medicine. OUCH!!!

This is what an idiotic family practice resident did to me at the birth of my second child. Waited 5 minutes for the placenta, then pulled the cord, which broke off, then plunged his hand into my uterus. No anesthesia, of course. This was worse than the birth was!!!! I was a clinic patient without any money or insurance, white trash, so I got the bottom of the barrel treatment at this hospital.

Then two weeks later the retained pieces came loose and I hemorrhaged while I drove myself to the hospital with my baby in the car (I grew up accustomed to nobody being there for me in need, & my husband was a selfish alcoholic and didn't care, so I just went). They eventually gave me a D&C later that day, after bleeding out so much I fainted when I sat up, and got a transfusion. The next day I woke up and watched the hospital TV as Ronald Reagan was inaurgurated as president ... yeah this was 1981.

C'est la vie.

Up Vote Up Vote ×
Specializes in LDRP.

30mins usually, though they do encourage it to come out with Pit, massage and a gentle tug. no forceful pulling.

and any manual removal on a no anesthesia pt goes to the or to be sedated!

Up Vote Up Vote ×
Specializes in NICU, High-Risk L&D, IBCLC.

I have only seen one retained placenta so far.....doc waited for an hour and then patient was in the OR under general anesthesia for removal.

Up Vote Up Vote ×
Specializes in OB, lactation.

Our MD's would be freaking if they had to actually wait 30 whole minutes for a placenta. We have one or two docs who pit before placenta, the others open it up just after placenta. All use traction and massage.

That said, I have to admit that I've only had one pt so far that the MD had to come back and sweep the uterus for hemorrhaging and I'm not even sure if there was retained placenta there or just clots or what. I've never seen anyone break off a cord. Never seen an inverted uterus (! don't want to either).

Up Vote Up Vote ×
Our MD's would be freaking if they had to actually wait 30 whole minutes for a placenta. We have one or two docs who pit before placenta, the others open it up just after placenta. All use traction and massage.

That said, I have to admit that I've only had one pt so far (probably around 300 deliveries) that the MD had to come back and sweep the uterus for hemorrhaging and I'm not even sure if there was retained placenta there or just clots or what. I've never seen anyone break off a cord. Never seen an inverted uterus (! don't want to either).

I would say that our providers are typically with an L&D patient for no more than 15-30 minutes for their entire labor and delivery from walking in the door to finish. If there's a problem or a lot of repair then of course it's different but that doesn't happen much.

Even if we misjudge the amount of pushing a patient still has to do when we call the MD and there's a little more to do (and I'm not talking a lot here), most of our MD's will actually walk back out of the room and do something else until babe's way on the perineum (one MD will walk in, visually look at pt's bottom, usually with a disgusted look on her face if not crowning, flip around in a huff and go get on the computer at the nurse's station. When I have one of those pt's that moves the babe down a lot with ctx, I'll have to say WAIT! and make her wait until a ctx so that she realizes, yes, you DO actually have to stay here!).

Wow, I would freak out if our docs waited until the babe's "way on the perineum". :uhoh21:

I call when they are complete or close (like with an anterior lip) and they come. They are usually there for the whole pushing part . . . .but they do leave pretty much after "Madame Placenta" arrives.

We don't give pit until after "she" arrives btw.

steph

Up Vote Up Vote ×
+ Add a Comment