Retained placenta is defined as placenta undelivered at 1-2 hours postpartum with no excessive bleeding in a homebirth situation (30 minutes in a medical facility). The average length of time for a normal placental delivery in a homebirth when the newborn is breastfeeding upon birthing ranges from 15 minutes to about 45 minutes.

Encourage natural delivery of placenta with complimentary therapies, including herbs, squatting, emptying bladder, walking, remaining in upright position, etc.

An easy way to encourage the placenta to separate is to breastfeed your baby, as nipple stimulation releases hormones that help your uterus to contract. Your midwife might use reflexology, aromatherapy oils such as jasmine massaged into the abdomen around the top of the uterus, or acupuncture to help the placenta to separate.

HERBS

Herbs like myrrh, or raspberry leaf may also be effective. Angelica root tincture (50 drops) and blue cohosh tincure (20 drops) every 2 to 5 minutes may be helpful. Homemade tinctures are usually best and more potent.

One suggestion would be to try some Cayenne Tincture. Wait 30 minutes. If the placenta has not been expelled, then give some Lobelia Tincture. After 30 minutes, try Cayenne again. Often this will do the trick. It's best to use your own fresh homemade tincture. Store bought Lobelia tincture is usually weak and worthless. Don't be afraid to take quite a dose. The reason herbs do not work for most people is that they don't take enough of them. The most that is going to happen with these herbs if you take too much i s that you will vomit. No other bad side effects are going to happen.

A tea made with angelica, black and blue cohosh, ginger, raspberry, and lots of honey.

HOMEOPATHIC REMEDIES

The homeopathic remedies below aid contraction of the womb and expulsion of the placenta.

Specific remedies to be given every 5 minutes for up to 10 doses:

Intermittent bleeding, retention of urine, lower abdomen hot, red, sore, and painful to the touch, especially if woman is of a mild, tearful disposition: Pulsatilla 30c

Bearing down sensation continues, pains strong and continuous but ineffectual, muscles of uterus no longer able to contract, woman throws bedclothes off and craves fresh air: Secale 30c

Vagina feels dry and hot, profuse bleeding, woman red in face, moaning, very distressed, and sensitive to slightest jarring: Belladonna 30c

Vulva and vagina extremely sensitive, severe cramping pains in abdomen, constant ooze of dark blood: Platinum 30c

HOMEOPATHIC REMEDIES On-Line Sources

Ritecare.com Pharmacy - Homeopathic Remedies
Cascade Homeopathics: Standard Kits
Hahnemannlabs.com - Homeopathy

Despite all effort, however, the placenta fails to come away either partially or completely in about 3% of births. This can happen even when drugs have been given to bring it away. Sometimes the placenta attaches to the uterine wall more deeply than usual, and it's more common if it happened at a preceding birth or you've had a cesarean section previously as there's scar tissue in the uterus. High Doses of vitamin E has been associated with retained placenta problems. From the 7th month of pregnancy until delivery, the mother should taper her vitamin E intake down to 400 IU per day.

Note: If there is bleeding, there is some or total placental separation. Heavy blood loss indicates that a considerable portion of the placenta is already separated (lots of uterine blood vessels exposed) so if manual removal is required, it should not be too difficult. Sometimes the placenta is fully separated but has lodged just inside the cervix, in which case it is easily grasped and removed. But if it is still attached, you must remove it.

If stimulation, herbs, and other techniques used for initiating contractions for placental separation are unsuccessful, perform manual removal.

A retained placenta stops the uterus from contracting effectively to prevent excess bleeding so it has to be removed manually. This is usually a straightforward procedure performed in a medical facility in a surgical room under general anesthetic, although it might be done under epidural if one is already in place.

If the procedure must be done outside of a medical facility (such as a homebirth situation) anesthetic will not be available to the mother. Manual removal of a placenta may be painful for the mother and may not always be successful. Sterile technique is an absolute must if manual removal is performed since infection often is an issue that may occur with this procedure. Thus it should only be performed in dire necessity.

The procedure is relatively simple. The midwife should put on fresh, elbow-length sterile gloves, pour some antiseptic over her gloved hand and insert her hand through the os, using her other hand at the fundus to prevent the uterus from being forced upwards. The midwife slips her hand between the edge of the placenta or separated portion (if the placenta has partially separated) and the uterus, then pry the rest of the placenta away, using her hand like a spatula and working her way across the entire surface. Once the placenta is removed, quickly go over the uterine wall to remove any fragments, then grasp the placenta and bring it down and through the os. The midwife should give methergine and/or pitocin, if she has this available, as soon as the placenta is out, and vigorous uterine massage should be started at once. Assess the mother's blood loss and vital signs. If her blood pressure is low, she looks pale, feels cold and clammy, or her pulse is thready or erratic, give oxygen and transport at once to the nearest medical facility, treating the mother for shock. If she is stable, push fluids, keep her warm and quiet, and continue to assess vital signs. The placenta should be examined carefully to be sure it is complete. If there is any question, take the mother to the hospital immediately for a consultation (she may need a D&C). Bring the placenta in case evaluation by a pathologist is suggested.

If unsuccessful, consult client's health care provider and prepare for immediate transport. If sections of the placenta cannot be removed manually and the mother continues to bleed, methergine can be given as a last resort (if this is available). This will cause very strong contractions and may close the cervix, but the priority is to save the mother's life at this point and minimize blood loss during transport, particularly if she has lost more than 3 cups of blood and transport time is more than 20 minutes.

Watchful wait if parents decline transport. It will be very important to be very watchful for placental separation, bleeding, and maternal vital signs. Keep the mother focused on the here and now and keep her interacting with the midwife, her partner, and her baby during this time.


Moonragon Birthing Guidelines - Variations of Labor & Birth

---

MoonDragon's Parenting: Placenta Disposal Rituals & Recipes

MoonDragon's Obgyn: Placenta Abruption

MoonDragon's Obgyn: Placenta Anatomy & Physiology

MoonDragon Birthing Guidelines Index

MoonDragon's Health Index

MoonDragon's ObGyn Information Index by Subject Order

MoonDragon's ObGyn Information Index by Alphabetical Order

MoonDragon's Main Indexlisting

MoonDragon's Homepage