What if part of my placenta doesn’t come out of my uterus? What will my care provider do?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

If part of your placenta doesn’t vacate your uterus within around thirty minutes after baby is born (something called a retained placenta), it will be evicted. As a full or partial retained placenta could cause hemorrhage (excessive bleeding) or infection, your care provider will utilize various methods until the entire organ has been birthed or removed. But you don’t have to be too worried about this, as it’s pretty rare. According to an article in the International Journal of Women’s Health, a retained placenta occurs in only 1 to 3 percent of deliveries.

There are three types of retained placenta:

1. Placenta adherens occurs when contractions are too weak to push the placenta out and it remains loosely attached to the uterus. This is the most common type of retained placenta.

2. Trapped placenta is when the cervix begins to close before the placenta has been expelled.

3. Placenta accreta occurs when the placenta attaches to the muscular walls of the uterus, instead of the lining of the walls. This is sometimes diagnosed before birth and usually results in the care provider recommending a C-section.

You care provider will check your placenta after its birth to confirm that it’s fully intact. If they suspect part of it is missing, they may perform an ultrasound to confirm. From there, they’ll take steps to remove the remaining pieces. However, it’s possible for a care provider to miss that a portion of the placenta is still in the uterus. In that situation, you might experience a fever, excessive bleeding, constant pain, or stinky discharge.

How does my care provider get it out? One of the first things they’ll likely do is administer medication that encourages the uterus to continue contracting. (This is often done preemptively.) Breastfeeding can also trigger contractions. You might also be told to urinate, as a full bladder can impede the placenta’s expulsion. If these methods don’t work, they may have to move on to manual removal, or surgery. In the case of manual removal, the care provider administers anesthesia and/or analgesia, reaches their hand into your uterus, and “sweeps.” Essentially, they feel around and remove lingering placenta. This doesn’t feel great — but it usually works. Surgeries to remove the placenta include dilatation and curettage (aka D&C), hysteroscopy, and laparoscopy. A hysterectomy is needed in rare cases. Antibiotics are given after the treatment to reduce risk of infection.

What to do

While there’s not much you can do to avoid the rare occurrence of a retained placenta, there are a few ways to be proactive:

Avoid prolonged use of Pitocin. According to the article in International Journal of Women’s Health, prolonged use of Pitocin could increase the risk of a retained placenta. So use Pitocin only if it’s absolutely necessary — not just because a care provider thinks it would be cool to speed things up.

Pay attention to your postpartum symptoms. If your care provider believes the full placenta was birthed but you experience fever, excessive bleeding, constant pain, or stinky discharge, or you just feel that something is off, let your care provider know so they can confirm you don’t have pieces of retained placenta.

Know how to stay calm if you experience a retained placenta. Stick a few of these retained-placenta-relaxation tools in your back pocket for the unlikelihood of this happening to you:

  1. If you’re told you have a retained placenta, immediately start taking deep breaths, helping to prevent panic from taking over.
  2. Have someone on hand to hold the baby, as pain medication may need to be administered. However, continue focusing solely on your baby until a recommendation is made and you make a decision. This can help your mind from spiraling into a place of fear.
  3. Keep reminding yourself that you’re being taken care of by trained professionals. While it’s not fun to have a retained placenta, they’ll take care of you, and you’ll be fine.
  4. If a manual removal or surgery is needed, close your eyes and envision your body filled with and surrounded by a warm, golden light that’s keeping you calm and safe.

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