QuestionAfter 24 hours of induced labor I had a c-section with my first child. More than 1 hour after the c-section was completed, my ob determined I had not delivered the placenta so she manually did this (without additional pain medication). It was more painful than anything else I encountered during my labor and delivery and resulted in 2 blood transfusions a day later. I am currently pregnant with my second child and am planning on using the same ob and having another c-section, I have a few questions because I am absolutely terrified that this will happen again (since I have read that women who have had one retained placenta are more likely to have another one:
1. When performing a c-section, is it common to pull the placenta out at that time, or attempt to wait to see if it delivers on its own?
2. Who in a delivery room is suppose to make sure that the placenta is delivered? (That is after my next c-section, who do I ask about whether my placenta has delivered or not?)
3. Should I need to tell someone to give me pain medication if they are going to remove the placenta manually? And if so, what generally is prescribed?
4. I have read that the placenta should deliver within minutes and not more than 30 minutes after the delivery of the baby, but it was MUCH longer than that with me, is that common?
5. What should I be on the lookout for (that is, is there any way for me to tell if my placenta has delivered or not?)
Thank you very much.
AnswerDuring cesarean section, the placenta is removed manually immediately after the baby has been born. Because the uterus is open, the surgeon has the advantage of being able to see and feel the placenta peeling away from the uterine wall. Many times the doctor will explore the uterine cavity with a lap sponge (a soft surgical cloth dampened with sterile saline) and also use a surgical instrument, typically a ring forcep, to remove any remaining placental material or placental membranes, (the sack the baby was encased in).
Know too, that in c/section deliveries, blood loss is a primary concern. The doctor will quickly facilitate the delivery of the placenta, so he can minimize blood loss and close the uterus and the rest of the abdominal wound safely and quickly.
In normal c/section deliveries, the placenta peels off of the uterus, creating a type of smooth plane. Rarely, the placenta will NOT do this, and a situation known as placenta accreta or placenta percreta exists - meaning the placenta has actually grown into the muscle fibers of the uterus. This is a rare occurrence. The doctor, as well as the scrub crew, will immediately recognize it.
In answer to your second question, the physician is responsible for making sure the placenta is removed correctly, just as he or she is responsible for performing a safe obstetric surgery that meets the accepted standards of care.
Typically when a retained placenta is diagnosed, and a secondary attempt to remove it is made, the patient receives sedation/pain medication through the IV, or anesthesia providers are in attendance. The latter is especially true if the patient is taken to OR for the removal of the placental fragments. Oftentimes a large curette - called a banjo curette - is used, and sedation or epidural anesthesia has to be in place. The patient could not tolerate it otherwise.
Regarding the placental delivery time frame... if your delivery is by c/section, refer to paragraph one. If you're going to deliver vaginally in a traditional hospital setting, the physician typically will gently help the placenta delivery along, and in the majority of cases, placental delivery is usually within 5 minutes or so after baby is born.
Regarding how to tell if your placenta has delivered, that is in the realm, and the responsibility of your healthcare provider.
Educate yourself, be aware, and the best of luck to you.
