After you have laboured and birthed your new born, your work isn't done!
The next stage of your labour is to birth your placenta.
HOW DO I BIRTH MY PLACENTA?
It is a wonderful time, finally holding your baby in your arms. It is a time perhaps to discover the sex of your baby, to examine every part of him or her.
The hour or so after you have given birth should remain calm, peaceful, and you should feel warm, cosy and protected.
This is important for bonding, but also to help you to birth your placenta.
The hormone Oxytocin, that was vital for you to labour and to birth your baby, is now important to enable you to birth your placenta.
CAN I BIRTH MY PLACENTA NATURALLY?
If your pregnancy has been straight forward, you have had good nutrition and the birthing environment supports the flow of your oxytocin, you can birth your placenta naturally, that is, have a physiological third stage.
However, like most stages of labour, there are policies and procedures the maternity staff like to follow.
WHAT IS A MANAGED THIRD STAGE?
A managed third stage is when an injection of artificial oxytocin is given to you to help you to expel your placenta. This drug is called Syntometrine and it is given as an injection into your thigh.
Policy dictates that you 'should' birth your placenta within an hour.
The evidence behind giving it is that it prevents excessive bleeding. It also reduces the length of your third stage.
After having the injection, your womb will contract, sometimes more forcibly than your labour surges. Your placenta needs to be expelled within 5-15 minutes, to prevent retention of your placenta, that is, it breaking away and some being left in your womb, as your cervix closes.
The Midwife will often use controlled cord traction, CCT, to help the placenta expel.
Like all drugs, there are potential side effects. These can include nausea and vomiting, headaches, tingling of the limbs, dizziness and palpitations.
There is some research that suggests a link between a managed third stage and colic in babies, as some of the drug can cross over to your baby.
HOW DO I CHOSE BETWEEN MANAGED AND OR NATURAL BIRTH OF MY PLACENTA?
If you have had a normal birth, that is without the use of forceps or Ventouse, you haven't had a cesarean birth and you haven't bled excessively, then there is no need to speed up the process of birthing your placenta. Yo can wait for nature to take its course. Usually within an hour you will birth your placenta, but I have heard of it taking longer.
If however, your birth has not been straightforward, then having Syntometrine could be vital.
You can opt for a natural third stage, but then change your mind on the day and opt for the injection.
HOW CAN I HELP MYSELF TO BIRTH MY PLACENTA NATURALLY?
Once your baby is born, having skin to skin with your new born and allowing baby to suckle on your nipple will help to keep the hormone oxytocin flowing.
If your baby is not with you, you can use nipple stimulation to boost the flow of your oxytocin.
Adopting a position that is comfortable and feeling warm and supported will help.
Gravity helps too. The toilet is a great place to feel private, be upright and have a clean up after as well.
You can chose to birth your placenta in the birth pool or bath, if that is where you have birthed your baby. (If you are planning to keep your placenta, this wont be possible as it needs to be kept in its natural state.)
LOTUS BIRTH
A Lotus birth is when your baby is not detached from the placenta. Their cord is not cut. The placenta cord will dry up and detach after 3-10 days.
In the meantime, the placenta can be washed and dried and sprinkled with salt, lavender antiseptic and herbs. Another practice is to keep the placenta exposed to the air. A third is to wrap it in a cloth.
A Lotus birth is thought to enable baby to have a slower and gentler transition into life outside of your womb.
A Lotus birth also ensures you are resting and can be more secluded in the early days postpartum.
FINAL THOUGHTS
The Royal College of Midwives said in 2008 that a physiological, (normal), third stage 'can be seen as a logical ending to a normal labour.'
There is research that suggests active management of the third stage should only be received in the event of actual bleeding.
Your Midwife or Doula can help you to make a choice about how you birth your placenta.
The book, 'Birthing Your Placenta' by AIMS is a wonderful resource.
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