Have you heard of a retained placenta? If you have, it’s probably been at the end of a particularly worrying birth story, but if you haven’t, you can probably ascertain what it is from the name…
A retained placenta is just that – a part (or all) of the placenta is retained or left behind in the uterus during the third “stage” of labour (the placenta part).
Usually, it is picked up straight away, as the midwives (or yourself if freebirthing) check the placenta upon delivery to make sure it is intact, but mistakes happen and some can get missed. There are always signs that there is something going on before it gets too scary – but they shouldn’t be ignored – let’s get into it.
When is a placenta considered “retained?”
If the placenta is delivered and studied, it may be visible that there is a piece missing that is still attached to the uterine wall. If the placenta is still not delivered after a period of time (hospitals like to have a placenta out within an hour) then that can also be considered a “retained placenta”. You can make your own call on the second one, as some mums have taken up to 6 hours to birth their placenta naturally after a physiological birth – and every mum, baby and placenta is different.
What causes a Retained Placenta?
There are several factors that can lead to a retained placenta, such as:
- Uterine atony (failure of the uterus to contract after childbirth – perhaps after an induction using a synthetic oxytocin. Neuroreceptors in the uterus can become insensitive to uterotonics if they have been part of the whole birth process. The best way to get a uterus contracting after birth is by having bub on mums chest, nuzzling boobs and mum smelling that glorious newborn – this will get the mum’s oxytocin flowing).
- Placenta accreta (placenta attaching too deeply to the uterine wall – the risk of placenta accreta increases with c-section births, something that is not often discussed when OB’s push a C-S).
- Placenta previa (placenta covering the cervix – also a higher risk to mums who have had a previous C-S, but usually found during pregnancy so that a plan can be made).
- Placental abruption (premature separation of some or all of the placenta from the uterine wall – very rare, happens in 0.5-1% of pregnancies in Australia)
- Uterine inversion (turning inside out of the uterus – extremely rare – one of the risk factors for this is cord traction by an unskilled professional).
How will I know if I have retained placenta after a few days or weeks?
- Heavy bleeding after childbirth, along with large clots or pieces of tissue
- Abdominal pain
- Foul-smelling vaginal discharge
- Fever or chills
- Failure to pass urine
If you have these symptoms, it’s best to get a diagnosis from a GP. They will usually organise an ultrasound for you which will show that some tissue is left in the uterus. They will then refer you to an Obstetrician/Gynaecologist who can remove it safely.
How is a retained placenta removed?
If the midwife has flagged that part of your placenta has been left behind following delivery and you are in hospital, medication can be given to help the uterus contract further and get the last bit out.
If that doesn’t work, then an epidural or anaesthesia will be offered for a manual procedure to be undertaken, or if you prefer a general anaesthetic that could be an option too. Doctors can then remove the remaining parts of the placenta so that recovery can begin.
There are decisions around this that you can make, which may include being awake during the procedure so that you can still be skin to skin with your baby or have a partner with you while they have skin to skin.
Not every retained placenta is an emergency, and you should be provided with choices and options.
Of course, the symptoms noted above should always be listened to, and try to listen to your body just like you learned to during pregnancy.
If not treated immediately, retained placenta can cause various complications such as:
- Infection in the uterus or surrounding tissues
- Haemorrhage (excessive bleeding)
- Anaemia (low levels of red blood cells)
- Endometritis (inflammation of the lining of the uterus)
Please know that these are super rare, and that with good care – complications don’t escalate to these levels.
Things to take away from this…
- Retained placenta does happen, but only in 1-3% of deliveries, and it’s not usually a serious concern for you or bub.
- The best chance of having a placenta come out whole is by optimising physiology and birth hormones.
- If a placenta is retained, doctors are extremely skilled at getting the remaining parts out so you can get back to bonding and loving on your baby.
- Birth has risks, sure, but so does everyday life. Find a way to work with the risks you feel comfortable with and navigate around the risks you don’t. Only you can evaluate your risk factors. If you need help navigating your pregnancy, a doula can help you along the way with evidence-based information.
My name is Brittney Blakeney, and I am a qualified doula who has trained at the Doula Training Academy. If you would like more information about my doula services, please contact me:
0424 611 886