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....)

I'm working as a travel nurse in a place like you work, mitchsmom. This kind of care by an OB disgusts me, but they're not going to change, so I play little miss nursey-nurse and do my job with a minimum of conversation with the OB, and give my pt the best care I can. They are old white male dinosaurs who are rude to the staff and pts and the staff have coddled this behavior for decades because they are The Doctors. The travelers, of course, talk about this place on the travel nurse boards and roll their eyes privately at this kind of care, knowing that there are alternatives out there. These OBs literally walk out of the room if the baby's head is not halfway out. Some of them are so bad they don't even speak to the pt. They don't say to the pt, "I'm going to cut an episiotomy." Of course this kind of OB always cuts an episiotomy. They just start jabbing the perineum with lidocaine until it balloons up (some use 2 vials) and cut away, and the pt's never question it. On the plus side they OBs are there such a short time we don't have to deal with them for long. The more educated and affluent women in this community drive 30 miles away to the Other Hospitals, with CNMs and better OBs for their deliveries.

The "Madame Placenta" part gives me a chuckle. I may start calling it that :)

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That is completely unsafe to wait until the baby's head is at least halfway out . . . how do they suction a baby with mec???? How do they know if the cord is around the neck?

I wouldn't work with a doc like that.

steph

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Specializes in nursery, L and D.

So, this is how the entire delivery part goes with most of our OBs. They call me and doc when the babies crowning. I usually get their first. (I'm in nursery, and we go to all delvieries).....they come in, catch the baby, give the baby to me, deliver the placenta within 5 min. or they are going after it, look at the mom, says "you're fine" and walk out. The whole time the mom is saying "thank you soooo much dr soand so" They are usually in there way less time than me, and I only stay to do APGARS if all is well. Then the mom turns to the L and D nurse and says, "where is my pepsi, you said I could have a drink". Where the heck is the thanks to the nurse that just held your big, dead leg while you pushed for 2 hours? Ok, rant over.

The only time I have seen most of our docs wait for a placenta is in the case of a pre-viable baby, those things take forever! And in that case they usually wait at the nurses station for it.

We do have one that will wait for the placenta to deliver on its on. When he is not in a hurry or sleepy, that is. And he opens the pit up with all, to speed it along.

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Our nurses labor down if possible and call doc to arrive just as baby is ready to be pushed out. I thought at first telling mom not to push was cruel, but there's actually much less intervention this way.

Most docs will be patient with gentle cord traction and wait a while - at least 15-20 minutes. Not sure about the outer limit. I'm usually busy with the baby.

A few will sweep the uterus if they suspect retained placenta. I've seen manual removals with epidurals, stadol and nothing. That part I don't like, even though it is over quickly, it is inhumane.

We don't give pit until placenta is out. Nurse has it ready to go and adds it to the IV bag as soon as doc states 'placenta is out'.

Anyhow - for many of the reasons in this thread, I gave birth at home with a midwife.

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We don't give pitocin until the placenta is out either . . . .

steph

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Specializes in postpartum, nursery, high risk L&D.
The whole time the mom is saying "thank you soooo much dr soand so"

this is the part that always makes me want to barf :barf01:

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this is the part that always makes me want to barf :barf01:

Aacckk, me too. Happened today at work, in fact. Worked all shift with this pt and family, husband, mom, mother in law, then this OB comes in at crowning and magically births the baby, which of course would not have come out of the mother without his presence. Immediately afterward, everyone chimes in "thank you Doctor! thank you Doctor!" He accepts the praise, leaves, and I clean up the pt and room and continue giving them care.

I'm fuming inside, trying to brush it under the rug, as usual. Same old, same old. Then the pt's mom comes up and thanks me for everything I did for her daughter. :) So I felt a bit better. She noticed, even though her princess daughter didn't!!!

(end of vent and sarcasm)

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Specializes in RN in L&D.

I just started in L&D and last week I had a patient that came in and delivered her baby with no interventions. In fact, the docs didn't even make it to the delivery. After about 15 minutes they started talking about a retained placenta. After about 20 minutes we rolled her down to the OR and as soon as we got into the OR she delivered the placenta. Had the docs waited a couple more minutes she wouldn't have ended up in the OR and seperated from her baby (her baby was taken to the nursery). For the most part the hospital is very low intervention I just couldn't believe that they were so eager to get that mom into the OR. Sorry I just had to vent.

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Specializes in Community, OB, Nursery.

The kind of crap I'm seeing makes me want to have my next child (if there is a next one) at home!

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Specializes in L&D, Postpartum, Newborn, Med-Surg.

Our Doc's have us start pitocin with the Anterior shoulder as a part of active management, but they wait 30 minutes for the placenta before intervention. I've never seen anyone "pull" on the cord, and thank GOD they do have us premedicate in the event they must intervene. I've even seen them have anesthesia use consious sedation.

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Specializes in postpartum, nursery, high risk L&D.
The kind of crap I'm seeing makes me want to have my next child (if there is a next one) at home!

me too, if only I weren't so paranoid...

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Specializes in nursery, L and D.
The kind of crap I'm seeing makes me want to have my next child (if there is a next one) at home!

:yeahthat:

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