Manual removal of the placenta, also known as manual extraction of the placenta, refers to a procedure done to remove a retained placenta after childbirth. In most births, the placenta detaches itself from the uterine wall and is expelled through the birth canal shortly after the baby is born. However, in some cases, the placenta fails to detach completely after delivery and remains firmly attached to the uterus. This is known as a retained placenta and requires manual removal by a doctor or midwife.
The procedure involves the doctor or midwife inserting their hand into the uterus and peeling the placenta away from the uterine wall. They will then remove it through the vagina. Manual removal of the placenta is usually done in the delivery room right after birth but may also be done in the operating room if complications arise.
So is manual placenta removal painful? The answer is yes, most women report that manual removal of the placenta is very painful. However, the level of pain and discomfort experienced can vary from woman to woman. Below we will look at why the procedure is painful, how painful it typically is, and what can be done to manage the pain.
Why Is Manual Placenta Removal Painful?
There are several reasons why manual placenta removal is described as extremely painful by most women who undergo the procedure:
– The hand has to go through the cervix which is normally very narrow and tightly closed after delivery except during active labor. Having a hand inserted through the barely dilated cervix is very painful.
– The placenta has formed firm attachments to the uterine wall which have to be forcibly detached by the doctor. This pulling and scraping on the inside of the uterus stimulates pain nerves and causes intense cramping.
– The uterus has to be manually massaged and compressed by the doctor during the procedure to help detach the placenta. This stimulation of the uterine muscles leads to very strong contractions which are very painful after birth.
– Having a hand inserted and moved around inside the uterus irritates the internal uterine tissue and causes discomfort.
– Women are often not administered adequate pain medication during the procedure since it is done emergently right after delivery. This lack of pain relief makes the experience even more excruciating.
– Large placentas that require more manipulation to remove are usually reported as being more painful.
So in summary, the main factors that make manual placenta extraction so painful include the doctor having to dilate the tightly closed cervix, forcible detachment of the firmly adhered placenta, strong uterine contractions stimulated by the procedure, and inadequate pain relief.
How Much Pain Should You Expect?
The level of pain and discomfort experienced during manual placenta removal can vary significantly from one woman to another. However, most describe it as extremely painful, often rating it as more painful than labor and childbirth itself.
On a pain scale of 1 to 10, with 10 being the most severe pain, many women rate the pain between 8 to 10. Some studies that surveyed women after the procedure found the average pain rating to be around 9 out of 10.
Some descriptive terms commonly used by women to describe the pain and sensations include:
– Excruciating, intolerable pain
– Severe cramping and contractions
– Feeling their insides were being pulled out or scraped
– Labor pains but multiplied in intensity
– Worse than early labor contractions
– Hot searing pain
– Unbearable urge to push
While some women may experience milder pain around the 5 to 7 range, most report the manual removal of the placenta as one of the most agonizing experiences during the entire birthing process. The intense pain is short-lived but very difficult to endure during the procedure.
Pain Management Options
Since manual removal of the placenta is known to be an extremely painful procedure, it is important for the doctor or midwife to provide adequate pain relief during the process. Here are some options that may be used:
– Local anesthesia – injecting the cervix and lower uterine segment with lidocaine helps numb the area and reduce pain sensations. This is often used but on its own may provide incomplete pain relief.
– Nitrous oxide gas – inhaling this mixture of gases provides some pain relief and sedation during the procedure.
– IV narcotics – intravenous administration of narcotics like fentanyl before the procedure provides some analgesia.
– Epidural anesthesia – If an epidural was placed for labor, increasing the dosage during the procedure can provide more effective pain relief from the waist down.
– General anesthesia – If the placenta removal needs to be done in the operating room, the woman can be put under general anesthesia to be completely unconscious during the procedure.
– Emotional support and reassurance – Having a doula, partner or nurse provide physical comfort and reassuring words can help the woman cope with the pain and stress. Relaxation techniques may provide some distraction.
Having adequate pain relief is crucial since the intense pain and stress hormones released can have detrimental physical and psychological effects in the postpartum period. Discussing your pain concerns beforehand and advocating for appropriate pain management can help improve this difficult experience.
Recovery and Outlook After Manual Placenta Removal
The manual removal of the placenta only lasts about 10-15 minutes, though it may feel much longer than that to the woman undergoing it. Once the placenta is fully detached and removed, the excruciating pain dissipates quickly. There may be some residual cramping as the uterus contracts down to its normal size.
After the procedure, the bleeding is monitored closely to ensure the uterus is contracting well and hemorrhage does not occur. An IV infusion of oxytocin is typically administered to encourage uterine contraction and reduce blood loss. Most women can be reasonably comfortable and back to their postpartum room within 1-2 hours after the placenta removal.
The recovery is similar to a normal vaginal delivery without excessive bleeding or infection. The uterus and cervix do sustain some trauma which can increase typical afterbirth pains. Pain medication and non-steroidal anti-inflammatories are recommended during the first few days postpartum to manage this discomfort.
Most concerning is the psychological impact of enduring such agonizing pain right after giving birth. Counseling may be beneficial to process the emotions surrounding the experience. However, the good news is no long term ill effects are expected. Future deliveries are not usually impacted, as typically the placenta detaches normally in subsequent pregnancies.
So in summary, while manual placenta removal is extremely painful in the moment, the unbearable pain is short-lived. With proper medical care, pain management, and emotional support, women recover fully to continue bonding with their newborn.
Conclusions
To conclude, manual removal of the placenta is widely regarded as an extremely painful procedure, often rated as more painful than labor and childbirth. The reported level of pain and discomfort is typically severe, described by many women as 8-10 on the pain scale.
The pain is caused by having to forcefully detach and extract the placenta from the uterine wall through the barely dilated cervix, which stimulates intense cramping and contractions. Since it is an urgent procedure done right after delivery, pain management is often inadequate.
Adequate and effective analgesia is imperative for reducing the trauma, both physical and psychological, of this painful procedure. Options include local anesthesia, nitrous oxide, narcotics, epidural anesthesia and in some cases general anesthesia. Emotional support is also very helpful.
While the procedure is mercifully quick, women report the pain as excruciating during the process. Thankfully, the pain dissipates quickly once the placenta is removed. With proper aftercare, there are usually no long term impacts on future pregnancies or deliveries. Seeking counseling can help women cope psychologically if the experience was especially traumatic.