If you’ve read my birth stories, you may remember that the third stage of labour hasn’t been completely straightforward for me either time. The first time, the midwife snapped the cord, which meant that the placenta couldn’t be retrieved before the womb started to close. This meant theatre, for a manual removal with spinal anaesthetic, after having a completely physiological birth up until the baby came out. The second time, I tried for a physiological third stage but was a little scared after 45 minutes when a large mass of blood came out (so big I thought it was the placenta!) and I decided with the midwife to have the syntocinon injection at that point. When I did, the placenta pretty much shot out, so the midwife felt it had already separated – hence the blood loss a few minutes before – and was just sitting there: the contraction caused by the syntocinon propelled it out then.
Both times my blood loss has been classified as a post-partum haemhorrage (PPH) – I lost 650ml of blood first time around and 600ml second time. So if there’s anything I was nervous about for the birth of this baby, it was significant blood loss.
Last week, my fab midwife gave me this booklet, Birthing Your Placenta, which is produced by the Association for the Improvement of Maternity Services (AIMS) in the UK. It’s a detailed discussion of both physiological and managed third stage of labour, and the evidence surrounding both approaches. I’d been doing a lot of work anyway on feeling positive about the third stage of labour, but I found this booklet hugely reassuring. I felt a big deal was made out of my blood loss last time in hospital (although I hadn’t even been informed of a greater blood loss first time around!), yet my iron levels were still good after and I wasn’t symptomatic in any way. In fact, I was up and flying about on my first baby, out shopping within the first week and did far too much and ended up with mastitis – but that’s another story.
The booklet discusses that the impact of blood loss depends on individual circumstances – a woman could lose 1000ml of blood and not struggle after the birth – yet someone else could have blood loss that falls below the PPH classification level and have more difficulty. Our blood volume increases hugely in pregnancy and we have to lose this at some point. It’s been observed by midwives postnatally that women with a managed third stage can experience more blood loss after the birth. So while it may look like women with physiological third stages have greater blood loss, this seems to even itself out in the following days. I found after my ‘more than normal’ blood loss that I had very little lochia and my post-partum bleeding was all but stopped after the first few days. So perhaps a 600ml loss at birth is my normal.
It’s also pointed out that when we donate blood, 500ml is taken and considered to be safe. A point I hadn’t considered before and found interesting!
If you’ve had previous third stage difficulties or greater than normal blood loss, the booklet is definitely worth a read.