Welcome to the Kick Your Expert led podcast, helping you explore and learn everything about getting pregnancy, birth, and becoming a parent.

On the podcast and our online pregnancy program grow My Baby, we share my experience of helping more than four thousand babies to be born.

And our experience of running a women's health clinic and parenting for boys.

We're here to help everyone to feel empowered in pregnancy and birth with real life, practical information.

Welcome everyone.

I'm Bridgid Maloney, and today we're going to be doing a quick kick and we're going to be focusing on a retained plus center.

So I thought I would start by sort of talking about what happened with me when I had my babies, when they were finally born, you know, when they're finally out.

I realized by the fourth child that I had developed a bit of a pattern, which was, first of all, I would hold my breath waiting for the babies first cry.

Then there was this enormous relief when I heard that cry, followed by a rush of emotion.

Finally I would say is it a girl or is it a boy?

And longtime listeners would know that every time it was a boy and then for me, the next hours went on as expected.

And actually that would be a good episode topic for another podcast, but this podcast is about retained placenter and so for my third stage or management of the plus center, it was just incident.

For you, it just happened.

But for some women this story doesn't end there.

When the placenta doesn't come out as expected, everything can change in an instant.

Today, our quick kick is from one of our longer episodes about retained placenter and retained products, but we wanted to give everyone a bit of a refresh on what it is like if you have a retained placenter.

Pat and I chatted about this and we thought, actually, let's start with us.

And this story is fictional, but it's based on his experience of helping more than four thousand babies to be born, and also on what we get told by you, our dear listeners on our dms.

Often this story is prefaced with her everything was fine until it wasn't.

So.

Her name is Emma and for her first birth, she was active in labor for a long time, about ten hours.

She was exhausted, but was close to the finish line and ready to push Buoyed by a rush of exhilaration, she pushed out her baby girl, a screaming bundle of bliss.

She named a straightaway her Charlotte.

For a moment, everything was calm.

Charlotte snuggled in chest to chest and together mum and bub tried breastfeeding for the first time.

Emma had an injection to help her uterus contract, but after thirty minutes, her obstetric tried some gentle attraction of the placenta chord and the midwife started rubbing her tongu which she found really unpleasant.

The placenta was still not delivered, and then suddenly Emma began to bleed really heavily.

She remembers the rush of staff, the urgency in their voices, and being wheeled into theater to have a manual removal of her placenta.

Emma didn't have an epidural in place, and the fastest thing to address the bleeding was to have a general anesthetic.

She woke up to Charlotte in her partner's arms, Dad and daughter together as a family.

She was thrilled and felt she could finally breathe, that they were all safe, but she still has not quite processed the fact that, after all her hard work throughout the labor that she felt robbed of that first chapter of her baby's life.

She didn't know anyone else that this had happened to.

She hadn't even realized that a retaining placenta could be so traumatic.

We tell this story because we don't want anyone to think, why did no one tell me?

We hear constantly that our program Grow My Baby is the reason that people have a knowledge bank to draw on during their pregnancy and birth that helps them feel calm, even if their pregnancy and birth takes a path they didn't expect.

This made us think that we want more people to have the program.

So for the next two weeks, we're going to for the very first time, put our programs on a Black Friday sale.

So if you're listening to this between November eighteen, twenty twenty five and December first, our Signature Pregnancy and Birth program will be discounted by twenty percent.

That is, week by week, in depth information about your pregnancy pain relief techniques in labor and birth, common interventions, how to ask informed questions of your providers.

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There really is all the information that you need in over fifty bundles which you can either access by drip fed week by week or you can binge at your own pace.

It's all aimed at building your confidence right through your pregnancy and the first six weeks of cuddling your baby, so you will never have to say why did no one tell me this?

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Go to grow mybaby dot com dot au and use the code baby twenty baby is all capitals to get your twenty percent off.

The link will also be in our show notes, or just drop us a DM and we can send you the link to that as well.

Now, let's catch up with doctor Pat to learn more about retained placenta at birth.

So can you define for us what a retained placenta is.

Well, that's a placenta that's still in place.

After Now, so the whole lot, all of the placenta, right, is that what you mean?

Yes, yes, well you might.

Well it's a good question.

See, sometimes you pull on that you pull gently on the cord to encourage it, and maybe maybe the cord snaps.

Okay, so the bit of the cord up near the placenta might come out, but not the placenta itself.

And occasionally it gets just a little bit coming out, but not most of it.

And does it ever happen that you've seen that the placenta comes out in bits?

Yeah, it can come out in bits, and so we need to be confident that it's all out or practically all of it is out.

And if it is, sorry to describe it like this, but if it does look like a beef brisket, how can you tell that it's all out.

Well, there's a couple of different techniques.

Especially if someone's bleeding and you get the whole percent out, they pubbly stop bleeding.

The placentda can be put out on a table and arrange so if it's in bits, you can put the bits back in like a jigsaw puzzle and say, okay, it looks pretty complete.

Yeah, And if there's a big bunch of jigsaw puzzle pieces missing, then they're probably still inside the patient.

Yeah, right, do you have to that very often?

We always examine the placenta to make sure it's complete every single time, but it's it's it's not incomplete very often.

Okay, how common is it to have a retained placenter?

Well, it depends on your time limit.

Somewhere between one to three percent.

Is that it seems to cover most of the international.

Data and your in your opinion, like three percent doesn't sound like a lot, is what do you think is that?

Is that three percent plenty of people?

So, and this is a significant this is a significant complication of birth.

It is what's behind quite a large number of the severe post partum memormages that happen.

Yeah, okay, the uterus finds it really hard to clamp down if the placent is still in there, And it's the uterus clamping down that stops everybody from having a post part memorrhage.

Yeah, So tell me, is there actual reasons why it happens or is it just random?

Yep.

Sometimes it's just what doesn't want to come out, it's just a little bit stuck, or the vix is trying to close up again, Yeah, or an inexperienced person maybe has pulled too hard on the cord and broken the cord, and therefore there's nothing left to pull on anymore.

The placenta sits in there, and and sometimes, and this is more serious, sometimes it's abnormally stuck to the inside of the uterus.

I know that's got a name, hasn't it.

That's called placenta, a creature.

And that's a bigger problem because you you know, if you pull on that percenta, won't it won't come out right.

What does the cervix close too early?

Well, everyone's service can close eventually.

It can get it close up eventually.

And I think you know, if you examine someone in an effort to get a placenta out, to get it unstuck.

The cervix has always closed a bit after the baby comes out, but not normally enough to hold the placenta placenta back.

Yeah.

And so if the placenta has properly disengaged from the internal aspect of the uterus, and especially if there's a little bit of gentle traction on the cord, then it'll it'll push that partially closed to back open again and let the placenta out.

And why do some uteruses not sort of contract down again?

Yes, so the placenta might still be in the uterus because the uterus just isn't clamping down enough to shear the placenta loose from the internal aspect of the of the uterus, and we might see that that's the so called atonic uterus where it just won't clamp down properly.

And we certainly might see that in a really really long label where the uterus is too tired, or where we've used tons of sintocinon and really pushed that uterus a lot so that it's too tired.

Yeah, Or if the uterus has form for not contracting down like this happened last time and the time before that, yeah, in that woman, Or if the uterus has got a problem that affects its ability to clamp down, like it's full of u doine fibroids and the muscle just isn't as good.

And what about like differently shaped uteruses, do they?

Yeah?

So sometimes the heart shaped you rists don't contract as well as the normal shape and it's hard to contract as well.

If the uterus has been over over distended in the first place by twins, triplets, yeah, really big baby or polyhydromnos you know, way too much water.

Oh yeah.

And so for example, if any of those things, if this is the vaginal birth of twins, or if a really big baby, or a reason why we would expect the uterus to contract poorly, then ideally we would have identified that as a potential problem during the labor and been ready to go to manage it quickly if it actually happens.

And that's that third stage management.

Yeah.

Yeah, So normally we might give just just the injection in the leg that helps the uterus contract and the placenta disengaged.

But for someone who was a sitting duck for this problem, like they'd had it happen before, then we might also put up a bag of sintosin to help the uterus contract, or put some tablets in your bottom and to help the uterus contract.

We might do extra staff, knowing that if we don't we're more likely to run into trouble.

I know this is about obstetric management, but what if you've given too much sintosinin and that's the reason why the uterus wasn't contracting down like what's in your tool kit, then not more sintoin.

More stuff to help the uterus contract in other ways yea, and so getting that you like rubbing it.

So if someone's come jumping on your tummy and rubbing your tummy to try and get that uterus to contract, it's all about tones.

We want the uterus to contract firmly, the placenta to be expelled, and then the once a placenta is out, the bleeding will stop.

And what about caesarean verse, Like, you've got a few pretty.

Good view there is the Yeah, well you don't tend to get the one at caesarian section.

You won't get the ones that are stuck for no apparent reason because if they they're stuck in this, put your hand in and take it out.

Yeah okay, and you can easily get your hand in the plane between the uterus and the urine wall and the placenta and just help it disengage.

But we certainly some of those ones where it's abnormally stuck, they may be diagnosed at cesarean section.

Oh yeah, okay.

Sometimes the well, the risk of the placenta getting abnormally stuck depends on a number of factors, but one of the important factors is if the woman's had multiple previous caesarean sections.

Yeah, so, if she's had multiple previous caesarean sections, then this birth's going to be by a cesarean section.

And sometimes we don't know that the placenta is abnormally stuck until we try and get out that section.

So thanks everyone for joining us in this episode.

If you found this story helpful, fantastic, If you know of somebody that also would find it helpful, please share it with them, and if that person or yourself would benefit from expert information throughout their pregnancy, we invite you to jump on the Black Friday sale to receive twenty percent discount on all our programs.

Please use the code baby twenty babies all in capitals at checkout at our website growmobaby dot com dot you All right, for now, keep well, keep growing those babies, and we'll be in your ears next week.

By for now.

Hey, even though doctor Pat is well a doctor and we get lots of other doctors and other experts on our podcast, I just need to remind you that this podcast is for informational purposes only.

We share lots of medical insights and experience, but everything we talk about is general in nature and may not apply to your specific situation.

Please always consult with your own healthcare provider for your individual medical advice.

When you grow your baby,