Hot Topic: Placenta Delivery

Sep 6

Kaely Harrod 00:04
Welcome to doula Tips and Tits. This podcast is a place where we answer one question about doula work, both to support you and to help you support your clients. I'm Kaylee Harrod. I've been supporting families in this perinatal space since my oldest was born 12 nearly 13 years ago. I am a birth and postpartum doula childbirth educator, La Leche League Leader and a doula coach. I love guiding and supporting doulas as they work out their doula business. It is a tremendous joy to be trusted in this way. Thank you for joining us on this journey. Okay, our next point of view episode is about placenta delivery. Now, I like to talk about placenta delivery in the fact that it kind of depends on where you're giving birth, right? Because how placenta delivery is managed is very different in in hospital versus birth versus out of hospital birth. So there are kind of two ways that we frame this one is expectant waiting, which is exactly what it sounds like that we like, give the placenta time to be delivered, right? The other is active management. That's where something is happening to help the placenta come now, there are contexts in which one or the other is safer. So this is one that if you're super into evidence based information, it's a little bit tricky, because how the labor is going and what has been added to the process really is a big part of what is safer. The other thing that's tricky about this is part of it is how it's done by a provider. And I'll explain what I mean by that in a minute. So it's one topic in the midst of birth, that is not as straightforward in terms of like this one option is absolutely always every single time the safest option, that's just not the case. So this is a scenario where you have to have a little bit of nuance in how you're teaching it. And also just how you think about it, because it is different for different folks. Okay, so in an out of hospital setting, one thing that's important to note is that people who give birth at a home, like home birth or a birth center, are already low risk, folks, right there in the US, at least, there are many rules around who can and can't give birth at home, in part because there's risk involved with not being near some of the medical interventions that are out of hospital, right. So we tend to see that the home and birth center crowd is a lower risk crowd of folks, which means the chance of something like a postpartum hemorrhage, or placenta retention are both a little bit lower in that group, right. The other thing is that if you're giving birth in a birth center, or a hospital, I mean a birth center or a home, you haven't been on an epidural, you haven't had a medical induction where you've had Cytotec or serve Adele or Pitocin, or any of those things, right, because it is a birth that is naturally kind of playing out on its own. That's because the scenario that you're you're picking, that's how that goes right, it doesn't mean that you haven't maybe had like some, some comfort measures, of course, but some of the medications that we associate with higher risk of like postpartum hemorrhage and things like that are not a part of those birth scenarios. So that's also a factor. So usually, in an out of hospital birth, we're going to start with that. So usually in an out of hospital birth, the baby is delivered. And then the placenta is given time to come now, they're the providers are, of course checking how much bleeding someone's having, they're checking, you know, if the cord is finishing, pulsing, and seems like it's kind of getting a little longer, so it's like detaching from the uterine wall. So they do still have some of the tools that the hospital uses when there is excessive bleeding, or when there is a placenta that's kind of stuck and doesn't want to come. They also have policies or should have policies around how long is too long for the placenta to still be on the inside. And at that point, they usually have a policy for transferring to a hospital so that some of the more sort of medicalized things can be done to help the placenta be delivered. Okay. Now, on the flip side, in a hospital setting, typically you see providers managing the placenta delivery with something called active management that most often can combines three different practices. One is fondle massage, which is actually part of an out of hospital birth, typically as well, at least a little bit, but not as much But not in such a routine way as an in in hospital. The second is IV Pitocin. So Pitocin is a synthetic form of oxytocin. And it's used in scenarios like induction and augmentation of labor, which is just helping labor along. And then, and then tugging on the cord attraction on the court. So, so when we're thinking about risk factors of these three things, Pitocin is an incredibly low risk for the postpartum time. So during that time, we know that your uterus actually benefits from clamping down a bit more in a bit faster. Sometimes when a uterus has had some assistance with clamping or with current with contractions in the labor process, it needs some assistance in the clamping down. So in a scenario where someone's had Pitocin, or in a scenario where someone's been induced, then those are situations where the research actually shows us, it's significantly safer to have that postpartum Pitocin. Because the uterus hasn't been doing the whole process by itself. And so we might also need to help it finish this last bit of the process, right. The part that carries the highest risk of these three portions is the traction on the chord. The tricky thing about it is that traction is risky, depending on how it's done. So the providers technique and amount of traction is what raises the risk factor. The thing that's really hard about that is that it's super hard to know in advance, which provider has like a safe traction, which provider doesn't, right? It's very, very hard to know. And so this is again, a topic that I always recommend people talk to their provider about both to see kind of what is their usual, but also to see what is their response. If you're saying, Hey, I know I'm giving birth in a hospital, but I'm going to be unmedicated. If I do successfully do an unmedicated birth, and I haven't had any medicine added, would you honor my request to do expectant waiting, even though active management is kind of your typical thing, right? So this is sort of a scenario where you're thinking through like, what is the birth that that this person is planning? And also what are the risk factors that this person has? And also, what are the norms of this provider? And also, where are they giving birth? So there's a lot of nuance in this one, but it's important for clients to know what goes into it. I do not teach this because I think every single person should make the same decision about it. So I want to be really clear on that. I don't actually think it's always good to avoid postpartum Pitocin, for instance, like I, I think there is a lot of research to suggest that in a hospital setting, when someone has an epidural or when someone has been on Pitocin, there is actually a tremendous impact in terms of lowering postpartum hemorrhage. So so I am not teaching on this particular topic in order to say like, let me tell you how the hospital has a terrible policy, that is not the case, right? What I'm doing is making sure that people know what is involved in that process. Because what I often see is that once the baby's delivered, the team kind of does their normal thing. And then the patient sometimes doesn't get told what's happening. So they might not realize that they're on a high amount of Pitocin. Or they might not realize that they're having some traction that on their cord. And I think those are important things to know, even if you're totally fine with them, it's still important to know like, Oh, hey, my provider is helping my placenta be delivered. And they're helping the placenta be delivered in these two ways, right? It's important for people to have informed decision making and that is part of this process. So I just want to add that clarity because I do not want anyone saying like, Oh, Kaylee definitely hates postpartum Pitocin or whatever. That is not at all the case. That's not what I think. And that's not where this particular conversation is going. Okay. So, as always, connect with me on Instagram, if you have any questions about this, because I would be happy to have a further conversation around it. And also, if you have things to add to the conversation that you're like you missed this part, I would be happy to engage with you. I think that's a big part of how we learn. So please do connect with me over there. And I'll see you in the next episode.
Kaely Harrod 09:42
Thanks for joining us for this episode of the Doula Tips and Tits podcast. If you learned something today or had an aha moment we'd love for you to share that on Instagram and tag us at Harrod doula, so we can celebrate alongside you. If you found this podcast helpful. We would so appreciate you too. take me a second to leave a rating and review on your favorite podcast app that helps other doulas find us as we do this work together. This podcast is intended as educational and entertainment. It is not medical advice or business advice. Please consult your own medical or legal team for your own needs around your health and your business. We'll see you again soon.

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Placenta delivery is not the same for everyone. Some are at higher risks than others and also the location of delivery plays a big part as well. Therefore, it is important to ask your client what they want for their ideal placenta delivery before the birth happens.

Quote from the show:

“And so this is again, a topic that I always recommend people talk to their provider about both to see kind of what is their usual, but also to see what is their response. If you're saying, Hey, I know I'm giving birth in a hospital, but I'm going to be unmedicated. If I do successfully do an unmedicated birth, and I haven't had any medicine added, would you honor my request to do expectant waiting, even though active management is kind of your typical thing, right? So this is sort of a scenario where you're thinking through like, what is the birth that that this person is planning? And also what are the risk factors that this person has? And also, what are the norms of this provider? And also, where are they giving birth? So there's a lot of nuance in this one, but it's important for clients to know what goes into it. I do not teach this because I think every single person should make the same decision about it.”

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Kaely Daily is produced by Kaely Harrod of Harrod Doula Services

It is sponsored by The Birth Prep Blueprint Childbirth Class

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