This is a story from a Virginia Licensed Midwife who was caring for a low-risk person for their second birth. Retained placenta is defined as "lack of expulsion of the placenta within 30 minutes of birth of the neonate." Without pitocin, using what's called "expectant management," about 80% of placentas are expelled in 30 minutes, and it takes 60 minutes for 98% to be expelled.
When a placenta is retained, there is a high risk of postpartum hemorrhage and uterine infection. That risk increases the longer treatment is delayed. The number one cause of maternal mortality worldwide is postpartum hemorrhage, so it is imperative that all maternity care providers, including Licensed Midwives be trained in how to manage this complication and allowed to use the appropriate treatment to prevent severe postpartum hemorrhage.
The first line treatment for retained placenta is to administer Pitocin and to manage shock if the blood loss is severe. Licensed Midwives are trained to administer Pitocin and give IV fluids to treat shock related to blood loss, but our outdated legislation currently prohobits Licensed Midwives from performing these potentially life-saving measures.
The story below illustrates how access to Pitocin could have prevented this complication.
I am a licensed CPM and had a client G2P1 who gave birth at home without any risk factors. She immediately held her baby, and nursed her baby while we waited for indications that the placenta was separating. We monitored her vitals and everything was completely stable. The cord stopped pulsating, turned white, and was clamped and cut. At 30 minutes after birth we gave some herbs to encourage the placenta to release. All vitals remained normal but there were no signs the placenta was coming. The client walked to the toilet and urinated, still no placenta. The baby continued to breastfeed. After 1.5 hours, though all vitals remained stable, we started talking about transfer to the hospital and then called the hospital and transported by car at 2 hours postpartum (she lived 5 minutes from the hospital and all vitals were stable, no bleeding, fundus was not rising). The doctor on call at this small rural hospital was not very happy with us (he had to be called in from home) and immediately asked if we had tried controlled cord traction with pitocin. We answered that we had not because we were not licensed to carry or administer pitocin, which surprised him. The nurse gave a shot of pitocin and the doctor used controlled cord traction and the placenta was immediately delivered without excessive force or bleeding. The client chose to leave the hospital right away and returned home to her baby and had no complications postpartum. Thankfully her life was never in danger but having access to pitocin would have saved expense and hassle both for the client and the community hospital.
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