Diagnosing Hidden Bleeding

Hidden bleeding can be diagnosed simply by marking the height of the fundus after the baby is birthed. If the fundus grows higher due to blood filling up behind the placenta, then something should be done to encourage the placenta to come out as opposed to waiting patiently for it.

Physiological Third Stage

Mothers who choose to do this trust that their placenta is just like their baby. It will come out when it is ready, and not before.

They believe that if it is forced to come before the mother, baby and placenta are ready for it, this can cause the very problems that the 'managing' was meant to avoid. Some births happen in a short time, others take a long time - same for placenta birthing.

If this avenue is chosen, the mother needs to be aware that if she starts to feel sick, shocky, "wrong" or "off", or is bleeding excessively that there could be an issue with the placenta that needs to be acted on. She may choose to handle this herself, call back-up, or transfer to hospital.

Assisting The Placenta Out :

In hospital or with a backup midwife, giving assistance to placenta removal usually involves a shot of syntoctin or syntometrine (an oxytoic drug) that forces the uterus to contract hard and get the placenta out.

This has its risks and can cause problems like post-partum haemorrhage or aggravation of a haemorrhage that is already occuring.

If that fails to work, and the mother is haemorrhaging badly regardless of what drug is given to stop it, they may try uterine massage, cord traction, manual removal of placenta by putting a hand inside the mothers uterus to pull the placenta out, or surgical removal of the placenta.

At home, the mother is unlikely to do any of the above things by conscious choice or instinct because those actions are invasive and potentially risky to the mother.

It is a huge NO NO to pull on the cord, or massage the uterus BEFORE the placenta has been birthed. If the placenta is still attached to the uterus wall, this can cause partial detatchment, tearing, haemorrhage and adverse reactions in the mother such as pain or shock. It can also cause death due to massive bleeding.

But! It is important to remember there are always exceptions to the rule. There have been many mothers who have instinctively pulled a stubborn placenta out by the cord or massaged the uterus knowing it was necessary.

Those things were done by instinct, not conscious choice and in all cases, the placenta had completely detached and was just sitting in their uterus and there was no danger to them. However, only *their* bodies knew that information and it would be very risky to do so consciously without being sure the placenta was detached properly.

What to Try at Home

• Wait patiently if there is no cause for concern
• Breastfeed the baby for natural oxytocin
• Drink raspberry leaf infusion.
• Change positions
• Heed to your bodily instincts
• Get up, walk around a bit
• Try squatting
• Urinate. (If you have trouble doing this, try peeing in a squat over a bowl or in the shower with warm water.) Then walk around again.
• Take Angelicia tincture and/or Blue Cohosh under the tongue - dosage is 20 to 30 drops under tongue.
• 1/4 cup ground ivy herb infusion.
• Pushing gently with any contractions if there is an urge to push the placenta out

Placenta is out but still attached by the membranes

The trick is to twirl the placenta so the membranes rope up. This will gently loosen and detach the rest of the membranes inside and it will all come out with gentle wriggling. Try this after allowing some time to pass - sometimes the ends detach themselves with time or one of the above methods of helping the placenta out at home.

Experiences from women with delayed placentas

"We planned on waiting to cut the cord, but when 2 hours had passed, and the placenta still had not made her appearance, and nursing and holding a slippery newborn with a short cord got too much, we cut it. It was white and limp, and cold. I started stressing about how long the placenta was taking. I did some uterine massage, and found my uterus was already turning into a ball like it was supposed to. I kept checking for excessive bleeding, there was none, but it was hard to tell what was new, or was just dripping from the sac that had fluid in it still that was hanging out with the cord. I tried squatting, light pushing, but still no placenta. I had a few contractions, but no placenta. Around 3 I got up to rinse off the old blood to help determine if there was a lot of new blood. When I was in the shower I tried squatting again, I also tried gently pulling to see if I felt anything. I didn’t, but I was NOT going to pull for real, in case the placenta was still attached. I had Luis bring me scissors, and cut what I could from hanging too low. The sac kept filling with shower water, and blood, it was irritating. It looked like a little water balloon hanging between my legs. Luis found it slightly amusing to watch me waddle through the house with a plastic bowl between my legs to keep from dripping all over. Cyana finally woke up around 4. She said she heard the bay crying, and it woke her up. HUH?! Mama screaming at the top of her lungs for an hour straight did nothing to ya though. Luis had even gone in after we cut the cord to wake her, and she just rolled over. I was clearly stressing about the placenta, and Luis told me to just go lie down, and try to rest, and wait. I did. I had just started to fall asleep when I had to pee. I got up, had a contraction with a pushy feeling, and plop went the placenta into the toilet. The placenta was born at 6:10 am a full 5 hours after her baby. I felt so much better."

"I sat in the water - despite the fact it was cold and murky waiting for the urge to push out the placenta....it never happened. 25 minutes after the birth I'd had enough of the cold dirty water and the cord had stopped pulsing so I had DH cut it and I got in the shower. At almost an hour after the birth there was no sign of the placenta and only mild cramping...baby had nursed a twice for just moments so I decided to try again. He nursed for a good 15 minutes but still no urge to push and no placenta. I felt fine but I knew the placenta was supposed to have been out by now. I started researching and of course all the medical info said I would hemorrhage or get toxic shock syndrome etc if it was not out within an hour - it was almost 2 hours. I was barely bleeding and felt physically & mentally fine...none of the symptoms of a dire situation. I decided that if I saw lots of blood or felt sick I would call the midwife or go to the hospital. After about 3 hours and lots of blue/black cohosh (which again did NOTHING) I decided to instant message a friend and see if she had any advice. She was shocked that the placenta was still in and decided to IM a friend who'd had a UC birth to see if she had any advice....luckily she did she said to walk around for 5 minutes and then go pee....sounded WAY too simple. I did it anyway - even though I didn't like it (I just wanted to sit LOL). I went to the bathroom, sat on the toilet - NOTHING....I made myself pee (it didn't feel like I needed too) and decided this was yet another silly idea that wouldn't work. I stood up and felt a weird sensation - took one step and the placenta literally fell out onto the floor. IT WORKED (thank goodness for instant messenger, good friends - and ones that stay up really late ! It was 3 AM)"

"I did support for a couple that UC'd and their placenta took over 30 hours. No kidding. No bleeding, so she just waited. As a mw, I've waited 3 1/2 hours. That's my longest and I have to admit I was wondering what was up (could be, too, that I was tired and really wanted to go home)."

"I birthed it after 15 minutes. I didn't feel any need to rush or force it out. Actually, It took no effort on my part, except when the fibrous ends we still attached, then about 45 min later and me turning over, helped it all come out."

"Both my placentas came out within a half hour or so, but with my UC the membranes stayed attached and the placenta hung between my legs for over 24 hours. I had to call Pamamidwife for advice because although I knew everything was fine, I felt I was missing some piece of information that would easily help me get it out. I wound up twirling the placenta so the membranes sort of "roped up" and then reaching up inside and wiggling it back and forth until it detached. It took about 30 second total"

"I know a woman who took about 60 hours to deliver the placenta. Her labour took about 90 hours. Since her first birth was a c-section, it's possible she had a mild accreta and it took awhile for the placenta to release. Needless to say, she had a UC, since it would have been forcibly removed a very long time before if she'd been in a hospital."

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