placenta pulling and prolapse?

Gee, this is a hard one. I can see how you are mystified, and can hear the regret in your voice. We can only do what the best advice tells us to do. Forgive yourself, and rest up.

I wouldn't worry about it too much now. While you felt a rip, and there was no doubt some resistance which may have contributed to your prolapse, and you did detect prolapse the following day, prolapse so soon after birth may not be a great problem in the longer term. All your tissues are so stretched at the moment, and will revert to pre-pregnant state with a bit of residual stretching, over the next two years. In the meantime the endopelvic fascia are not providing any support for your organs, as with any postpartum woman. You might find it doesn't improve over the next few weeks and may even get worse, but in the second six months you should see improvement. We don't know why this happens, and the initial worsening can be very demoralising until the improvements start.

I would rather leave comments on what caused what to a midwife. I'll see if Aza will comment.

Some women do experience the whole uterus coming out with the baby. The midwife replaces it carefully, and sometimes the woman experiences no subsequent prolapse. The body is amazing.

I suggest you limit lifting and carrying to the baby, pull yourself up tall into Wholewoman posture, don't compress your abdomen, attend to your diet so you don't have to strain at all to empty your bowel, and enjoy your babymoon, and let your body heal.

Keep calling back. We will do what we can to help you understand and manage this.

Louise

Hey there birthing_free,

Welcome! There are a few other freebirthers on here so you are in good company ;)

"my placenta was not coming out after an hour and my contractions were becoming very painful at that point; I phoned a very competent and wise midwife friend of mine who advised my husband that my placenta was certainly detached at that point and it would be ok to give it a little "help" out."

From what you write, it sounds to me like your placenta was simply in the processing of detaching - which is why the contractions were so painful. Often once detachment is complete the contractions lessen significantly, whether or not the placenta has actually come out yet or not. So it sounds like the traction may have influenced not just the placenta, but your uterus. If a placenta is detached and just sitting inside the pelvis, doing gentle traction usually just feels like pressure on your tissues as it comes through your vagina, not a sharp sort of rip as you describe. Plenty of placentas - the majority in my experience - take more than an hour to come out.

What was your blood loss before and after the placenta came out? How long had you been having afterpains?

"I would certainly NEVER do that again no matter how painful the contractions were." There is a big difference between you - the birthing woman - doing your own traction as compared to someone who cannot feel what the tugging is doing. A wise midwife friend of mine said once, "Imagine picking your nose. If someone else does it, they are liable to hurt you, but if you are doing it yourself you most likely won't cause any harm." Haha, funny but true for placentas as well!
Plus, there are heaps of hands-off tricks for helping a placenta to come out that do not involve traction...

"Some women do experience the whole uterus coming out with the baby. The midwife replaces it carefully, and sometimes the woman experiences no subsequent prolapse. The body is amazing."
Louise, are you referring to hospital midwives? (In the US the term midwife doesn't mean the same thing as in Aus or the UK, where midwives are part of the medical system and hospitals...not sure where birthing_free is from).
I can only think of maybe two midwives who attend out-of-hospital births out of hundreds I have met through the years who have seen uterus' come out of the body to any degree that needs replacing! Yikes. This is more common in hospitals and related medical interventions (such as cord traction when the placenta is not detached;) )

Wondering what you mean by midwife not meaning the same in the US, Aza? We do have different types -- direct entry midwives practice in the home setting only, certified nurse midwives may be in the hospital or in the home, and lay midwives practice in states where midwifery is denied certification. Among the former two, knowledge and licensing are regulated. The latter can vary greatly in knowlege base.
Louise may be referencing a story I shared on here about my aunt-in-law, as told to me by her sister, my mother-in-law. This aunt had 8 home births, about 6 unassisted. Around the fifth baby, for which my mother-in-law was present, "Her uterus turned inside out and came out with the baby. We just pushed it back in, and she was fine." This aunt had more babies without issue, and does not have uterine prolapse today, some 35 years later. Though I wholeheartedly agree that women are better off birthing without medical intervention, whatever setting/arrangement that means, the truth is that s**t can happen no matter what when it comes to childbirth.

Birthing_free, how long ago was this birth? Pretty sure you've got lots of natural healing time left, and you can let this WW work help you along. I sometime get the "woulda, coulda, shoulda" thoughts too. Louise is right. Let them go, rest, and learn how you can maximize your body's potential to overcome POP. Best wishes!

Hi bad_mirror,

I could write a dissertation on this differences but generally speaking, midwifery within Australia and the UK is within the medical model, whereas in the US it gained legal status and public recognition as an autonomous organisation independent of the medical community (i.e. back in the day, midwives a.k.a MANA formed to create their own rules and regs before the medicos decided to). This is a fundamental difference that influences the cultural ideas of what defines midwifery, if that makes sense? This is just my perception after living in many different regions and a handful of countries and observing the similarities and differences; others may have different opinions for sure.

DEM's can work in birth centers in some states and lay midwives are most definitely in every state, not just where they are denied certification :) Many consciously choose this path despite whether regulation is available or not, i.e. Oregon has (had?) voluntary licensure for many years and there were heaps of lay midwives. I would also say that every group can vary in knowledge base...not just the ones who took responsibility for their own education rather than following the path of the institution.

Of course s**t can happen anytime but the reality of where it happens most, and where the most uterus' fall out, is pretty obviously not normally an out-of-hospital, non-mechanical birth environment.

(Sorry for the segue, birthing_free!)

Yes Aza, to clarify, I am referring to midwives in the Australian hospital system, and mostly older women from the twilight sleep days. I have very little knowledge of childbirth outside a hospital setting in Western Australia.

birthing free, how were your other two births? I very seriously doubt your third birth contributed significantly to your prolapse. Rather, I think it was probably a long time coming. Maybe even there before, just totally asymptomatic- which you can be sure that you will get back to some time in the next year or two. Your next pregnancy and birth are going to be amazing!

Thanks for the explanation, aza! :-)

Hi Birthingfree

Reading your account makes me realise how many interventions are done routinely in normal births in 'medical' settings. The birth process has been with us for as long as sex. Women are designed to do it (just like sex).

However, as in every process in nature, sometimes it doesn't go according to plan. This is where survival of the fittest or smartest becomes important for the survival of the species.

In the developed world we no longer have cemeteries full of headstones dedicated to young women and babies who died giving birth or being born. The price we pay is the mayhem we create in women's bodies in the name of preventing problems that may solve themselves, and overreacting to signals from mother or baby, in the name of having a live mother and a live baby. Life aint perfect. That's just the way it is.

I have had nephritis (pre-antibiotics), malaria, pre-eclampsia in late pregnancy, a bloody miscarriage, and too many times when lady luck was with me to count. I should be dead. I am not. My husband should have been widowed long ago. I have three adult children. Is this right or wrong? No need to answer this.

I am not saying you are being fussy or stupid. I know you are just wondering how this happened. I think the others are right. After three births, which have not been picture perfect, you have some prolapse, which seems to be pretty normal.

Now I need to ask you how your prolapses are now. Are they a problem now?

Louise

Have you communicated with your midwife friend about this, birthing_free? If I was in her place I would want to know what was going on for you (as well as possibly learn from the experience, and hopefully help you work through it).

Sounds to me like the placenta was not detached. If it had detached already, you would have had cramping already, for one thing. Also, usually there would be a separation gush (more than a small amount 99% of the time) and then when the placenta finally makes it way out, there is often just a huge blood clot attached to the maternal side rather than a flow of blood. In your case, this blood hadn't had time to sit and clot (i.e. because the placenta was not detached until the every end) so came out with a gush with the birth of the placenta. Having said all that, how things appear on paper is often very different than the reality...so take what I say with a grain of salt.

I agree with alemama and louise, and please try not to hold onto the placenta pulling experience...it would have taken a lot of force to cause serious harm, and I seriously doubt your husband would have been game to exert such force.
What is happening with your body these days?

Hey Birthing_free

I can understand your being really p***ed off about it. I would be too!

I didn't mean it to be a "Be thankful your're not dead" argument. I had one of those horrible high intervention births. It just about broke my heart. I felt manipulated and cheated, and deprived of the experience of birthing my own baby out, something I had very much wanted to do, from deep inside me. I got that with my third baby, and it made me feel really good, and was very rewarding.

I am now 58. I get no less cross now when a woman falls for the "I'm the doctor. I am here to help you" routine. I live in a rural area where the nearest maternity hospital is half an hour away, and the nearest decent obstetric emergency hospital is an hour away, in the metro area. We don't have a lot of midwife, non-hospital births in rural Western Australia, and few free births either, for various reasons. Sadly, a non-hospital birth was not even an option for us.

I am very grateful that I didn't die, either in childbirth or from anything else (so far, but that too will come), and that childbirth and being born are a lot safer for us than they were for pioneer women and their babies, but I am also aware of how many things are done *to* labouring women in hospitals for reasons other than medical necessity, which often seem to complicate, rather than simplify the labour and birth. I am also now aware of how precarious life is, and how it can so easily slip away, or be stuffed up by thoughtless individuals who are just reducing the level of risk that they expose themselves to by intervening and taking control.

I read today a news story about a woman in Australia who had a surgical swab left inside her for eighteen years, which has caused her no end of trouble, and was finally removed last week, along with the mass of scar tissue that had built up around it. It turns out that the surgery she was having on her bowel at the time was as a result of previous abdominal and pelvic surgery. I wondered how much of her suffering was as a result of the surgical interventions she had. Yes, there is an enquiry going on. It appears that the theatre nurse couldn't count when they counted all the swabs at the end. Sigh.

Life is not perfect. Never was and never will be. I am so sorry this has happened to you, and I hope that both you and your husband can now be more gentle on yourselves and forgive yourselves for something that was done at a time of great vulnerability. You're not being fussy and stupid. You are just trying to make sense of what happened. That is quite understandable, and you are allowed to vent about it here!

Louise

hi there, welcome to the site
popping in late here, havent had much time for the forums these days, but had to comment

I agree wholeheartedly, you SHOULDNT have to deal with a broken-ass vagina!!!!!! I totally hear your anger, that at 24 you're dealt with this, after working to ensure the most natural, healthful way to bring a child into the world. job well done, even if it left you with this crappy prolapse.
I found my POP in my early 30's and that was TOO YOUNG to deal with this. some women find their POP in their 60's and you know what? I bet they feel the same way.
its not so much the prolapse itself, because rationally we know that its not life threatening, its not debilitating once we learn to manage it, its not visible, its really not a big deal - on paper at least.
but its the loss, oh the LOSS that hurts so much. the loss of confidence in our bodies, in our sexuality, in our strength and wholesomeness. and at 24 its likely that this is your first such loss. and again, I agree, 24 is young to deal with this. but here you are, stuck dealing with this. and I know it doesnt help, but I'm sorry you are dealing with this. and I know this doesnt fix things for you, but please know that many of us have walked in shoes very similar to the ones you've got on now.
the anger is normal and valid. its part of the grieving process. it takes time, but it will morph into understanding of your condition and some acceptance which will allow you to move on. its painful, but its part of life. I dont think any human beings really have a life experience without any painful parts or loss.
so go ahead and shake your hands at the heavens and ask 'why me', or vent here, or do whatever it is that you feel like doing. I holed up in my house and pretty much cried for a full week when I found my POP. that was years ago. I've since had two more babies, my sex life is awesome, I'm active, I rarely think about my POP which, btw, was probably worse than yours and is now completely asymptomatic.
there is hope.

and fwiw, I agree with alemama, chances are your first births set you up for this rather than the placenta pulling this time.

((((((hugs)))))))

Hey granolamom, you're so right about women in their 60s feeling the same loss, frustration, etc. I am a week shy of 65 and discovered my prolapse eight weeks ago. It was emotionally devastating. I felt betrayed by my body. I fell into a black hole of grieving for four weeks. Now that I have been practicing the WW posture for seven or so weeks and feel as though I'm getting the hang of it and that I don't have to think so terribly hard about how I need to hold my body with every single move I make throughout my day, I am feeling better emotionally and physically. My symptoms are better, sometimes even very good. I so resonated with your statement about "loss of confidence in our bodies, in our sexuality, in our strength and wholesomeness." The kicker for me is that the prolapse happened after I had felt my best and strongest ever after having practiced Pilates for ten months! (Yes, I'm pretty sure now that in my ignorance I helped the prolapse along by doing Pilates.) I am really looking forward to again having an "awesome" sex life (I'm SO not there yet), and to being asymptomatic! I loved your post to birthing_free. And, birthing_free, I wish you well. --keh

You are not being fussy or stupid....not at all....and trust me, this forum is full of women who also won't settle for the 'just be grateful' card.
A lot of the help and info in her comes from getting right into what is happening with everyones prolapse and working on ways to improve it / them, so if you care to share with us how yours is manifesting, I promise there will be lots of helpful info!

Hi birthing_free, I've just read this post and I hope you are feeling more positive and content a few years on. I'm very grateful to you for sharing, as I had a similar experience 14 months ago with my second birth, I'm 31. I too feel let down by my body, which I feel was supposed to be strong, after a natural, fast, beautiful homebirth. My placenta didn't deliver, and when it did it had not fully detached. It pulled out some of my uterus, I did have a midwife, but I'm quite sure she hadn't ever experienced seeing that happen. I would love to know how you are now, if you had more children, if you are still sad and angry, wondering why and what, that is where I am, I'm hoping it will change with time. Thank you.