Delivering Your Placenta
Once your brand-new baby arrives, you probably won't be paying too much attention to anything else. But your OB or midwife has one more thing on her to-do list before she can ooh and ahh over your baby--delivering the placenta. "Once the baby's born, he's no longer our patient--he's the pediatrician's," says Marra Francis, M.D., an ob-gyn in Woodlands, Texas, and an author of the Mommy MD Guides. "Our focus is always still on Mom, because there are a lot of things that can still happen."
In most pregnancies, the uterus continues to contract after the baby arrives, to help push out the placenta. (And Mom may still be feeling the pain of contractions and the need to push.) The placenta is delivered as part of the afterbirth with a small gush of blood, from a few minutes to a half hour after the baby arrives. The doctor or midwife will examine it to make sure it's intact and that nothing has been left behind in the uterus. But odds are, you're probably going to be pretty focused on your baby instead.
But for some moms, delivering the placenta can be problematic--or even downright dangerous. "There can be major problems if it doesn't come out correctly, including hemorrhaging or even the need for an emergency hysterectomy," says Titi Otunla, a certified nurse midwife at Texas Children's Pavilion for Women in Houston.
In some cases, a small part of the placenta can remain behind in the uterus. "It can happen for many reasons," Dr. Francis says. "Any time you stick an instrument in the uterus, it creates scar tissue, and part of the placenta can stay stuck to that. If a woman's had her uterus scraped, if she's had a C-section, or any surgery, that puts her at risk."
If only small pieces of the placenta remain, the doctor may be able to leave it behind and treat it with a chemotherapy drug. "Methotrexate can kill placenta cells--they literally just die and shrink inside the uterus," Dr. Francis says. You don't have to worry about losing your hair or other side effects; this is a relatively mild chemo drug. "Side effects are usually mild and the drug mainly causes headache, fatigue, nausea, and diarrhea," Dr. Francis says.
In some instances, though, the uterus grows more fully into the uterine wall, and can grow into the bladder and other surrounding tissues, creating a dangerous complication called placenta accreta. "You can't always diagnose placenta accreta until you're trying to deliver it and it won't pull away," Otunla says. If it's diagnosed in advance during an ultrasound, you'll be able to plan ahead for how you'll treat it. "You can either plan to do a hysterectomy at the same time, or plan ahead for uterine artery embolization," Dr. Francis says. Embolization involves cauterizing the areas where the placenta has adhered. But if you don't find it until delivery day, there's only one course of treatment--emergency hysterectomy.
For other women, the uterus fails to contract after the placenta has been delivered, putting them at risk of hemorrhaging. "We tend to see this with long labors, with women who push for more than two hours or women who have received quite a bit of pitocin," a drug commonly used to jump-start labor, Dr. Francis says. "We often take it for granted that it's going to be easy-breezy, and that we're going to have a birth that's going to go exactly how our birth plan said, but it just doesn't happen that way. Fortunately, we've got antibiotics and blood transfusions; we can sew the uterus back up and use medication to get the placenta out if it's stuck."
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