It ain’t over ’till it’s over

Hands up if, before you were pregnant/had a baby, you didn’t even realise there was a third stage of labour… You have some contractions, do a bit of pushing, you have a baby, you’re all finished, right? Well not quite.

There is of course the matter of the placenta – that amazing organ that connects the umbilical cord to the wall of the uterus and sustains your baby until he’s ready to make a grand entrance.

As you probably now know, once the baby is born, the uterus will contract again allowing you to push out the placenta. Though it’s pretty large (on average 22 by 2.5 cms) it’s very squashy making it a piece of cake to push out most of the time.

There are however lots of decisions to make around the third stage of labour and you’ll need to think what’s right for you, bearing in mind the kind of birth you’re planning.

In recent times active medical management of this third stage has become very common. As soon as the baby is born the umbilical cord is cut and the mother is given an injection of a synthesised hormone (usually syntometrine or syntocinon) which is deisgned (often with a bit of traction on the cord) to cause the uterus to contract immediately and the placenta to be delivered swiftly.

A natural or physiological third stage is just that – allowing the body to produce the relevant hormone (oxytocin) itself and the mother to push the placenta out within her own time (usually within one hour of birth). The rather nifty design of the human body means that as a woman breastfeeds her baby for the first time large doses of oxytocin are naturally produced causing the uterus to contract. Incidentally this is also true after the baby has been born, meaning that in the first few days after birth, breastfeeding will stimulate the uterus to contract back to its normal size. Many women feel nothing, others feel anything from gentle tightenings to stronger period-style pains.

There is of course no right way to do this- only the right way for you. It is worth doing a bit of research in to the options and talk this through with your midwife and doula.

Broadly speaking women who have had medical intervention during the birth are usually advised to have a medically managed third stage. There is a greater chance of maternal blood loss if you’ve had some interventions and the injection causes the blood vessels in the uterus to shut down immediately minimising that risk. It also means you don’t have to stand around twiddling your thumbs waiting for the placenta to be delivered. Statistically-speaking,  women who have an actively managed third stage have, on average, 80mls less blood loss after birth than those who have a natural third stage. If you aren’t good on measurements do fill up a measuring jug with 80mls to see how much this is – it’s surprisingly little!

However there are quite a few downsides to this option and upsides to a natural third stage. Medically managed labours do have a  higher risk of the placenta becoming trapped in the uterus after birth as the injection promotes swift closing of the cervix. The cord traction can also lead to this as it can snap. This does unfortunately mean you’ll have to have it removed manually.

You will also need to have the umbilical cord clamped straight away. This means that a large amount oxygenated blood is left in the placenta and doesn’t have a chance to flow in to the baby. It also means that your baby can be immediately whisked away from you. If you have a natural third stage you can keep a firm grip on your new bundle until the cord has stopped pulsated or indeed the placenta has been delivered – giving you important bonding time and the best possible start for breastfeeding.

One of the best sites for information on this is the homebirth resource site (I know I keep going on about it, but it’s a great site for information whether or not you’re interested in a homebirth). They have lots of links to articles in the British Medical Journal and studies conducted on this very subject. They don’t, however,  mention that if you have a homebirth you might be asked to produce a mop bucket on which to sit to deliver your placenta  and this would be a very useful piece of information. Particularly if you have a square, metal bucket.

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