some questions about third stage

[firsttimemum2007]

when I was planning a natural birth and third stage, the midwife at the hospital wanted to write on the birth plan that we would wait 20 minutes and then I would have the injection. She stated that this was long enough for my "care provider" (I'm guessing she meant the obstetrician) to wait. She also said that as my careplan stated that we wanted to wait for the cord to stop pulsating before being cut, this would probably mean that by the time we'd waited for that, the placenta would be born anyway.

This has left me with some questions:
1. What, if any, is the relationship between the cord stopping pulsating and the birth of the placenta?
2. How is a placenta birthed naturally ie do you have someone pulling on it or let it come out on its own etc?
3. What is the obstetrician's role (private hospital) in birthing the placenta. Obviously if you need stitches, they have to wait until the placenta is birthed, but what apart from that?

[DANNIIM]

I am not real sure on the answer to your first question, but i would presume that the cord would fully stop pulsating before the placenta is birthed whether naturally or not. No. 2 i think they would still need to tug on the cord a little for it to come out, i know with me i was given the injection and think this happens while you are birthing your baby, that they pressed on my belly a couple of times and them tugged on the cord a little and then the placenta was delivered. Didn't hurt in the slightest. No. 3 you might get a bette answer from someone else as i have never engaged the services of an OB and as such the middie does all the work.

Hope i helped a little

[Tobily]

when I was planning a natural birth and third stage, the midwife at the hospital wanted to write on the birth plan that we would wait 20 minutes and then I would have the injection. She stated that this was long enough for my "care provider" (I'm guessing she meant the obstetrician) to wait. She also said that as my careplan stated that we wanted to wait for the cord to stop pulsating before being cut, this would probably mean that by the time we'd waited for that, the placenta would be born anyway.

Well at least they were honest about why they want you to have the injection....that's a rarity in itself

As far as your questions go I'll have a crack

1. What, if any, is the relationship between the cord stopping pulsating and the birth of the placenta?

None that I'm aware of (but I'm not completely sure...someone else might know more). Waiting for the cord to stop pulsating is to give the baby the benefits and extra volume of the returning blood.

2. How is a placenta birthed naturally ie do you have someone pulling on it or let it come out on its own etc?

No one should ever pull on your cord if you're having a natural 3rd stage. The cord pulling is part of a managed third stage because the placenta needs to come out before the cervix starts to close (which is does reasonably quickly after the synto in comparison to a nat. 3rd stage). But pulling the cord increases the risk that bits of placenta will be left behind, that the cord will snap, and your risk of PPH. In a natural 3rd stage there isn't the urgency for the placenta to beat the closing of the cervix...hence no reason for pulling. You just wait and it comes out

3. What is the obstetrician's role (private hospital) in birthing the placenta. Obviously if you need stitches, they have to wait until the placenta is birthed, but what apart from that?

This is where we get to the crux of the matter. The obstetrician cannot leave you, nor can you be moved from birth suite, until the birth is complete. That means until the placenta is birthed - because if you are going to bleed this is when it is most likely to happen. Birthing the placenta can take up to two hours (or longer) without syntocinon (although most often it's out within 1/2 hour or so). Obviously the thought of sitting around for another two hours, when they can have it all washed up in 10 minutes with the injection...doesn't appeal. Not to mention tying up the birth suite.

HTH

[shorty]

[/B]
No one should ever pull on your cord if you're having a natural 3rd stage.

I wish i had known this with the birth of my first son. It was horrible, i stated i would like to wait till the cord had stopped pulsating. So trying to hurry things(like they do in hospitals) the midwife was pushing on my stomach and pulling the cord to get my placenta out quickly . im glad i am now informed and will speak up to make sure it doesnt happen with this bub.

[Nelle]

Sorry I'm not too much help with your questions. My only thought is, if you really want to placenta to come naturally, if that's important to you, that 20mins doesn't seem like enough time to me.

[Carolyn Hastie]

Hi first time mum! Before I comment on your questions I would like to congratulate you for even thinking about the third stage of labour. Many women do not even know they have a placenta to give birth too. That is for a whole lot of reasons, one of which is that rarely is the placenta discussed in the visits in pregnancy and secondly, the placenta seems to be universally ignored in birth films.

The placenta is the most amazing organ. It is very intelligent and awesome in the complexity of its work and organisation of the whole baby growth and development. When a woman gives birth to the placenta, she is still in labour. That is probably one of the most important aspects of third stage. It is still labour. For many of us, we think the whole thing is over once the baby is born. That perception actually sends the wrong message to our physiology. Together with the 'routine' behaviour of health care professionals at birth, the natural physiology is therefore interrupted and the crescendo of oxytocin liberated at this most crucial time is aborted - interfering with mother baby 'bonding' and 'attachment' and uterine/placental interaction.

Michel Odent and Sarah Buckley have great articles on this most precious and important time and why it is good to leave nature to do her marvellous work with the birth of the placenta. I could go on for ages because this whole thing is just so fascinating and when, as a midwife, I work with women who want to birth their placentas themselves and I see amazing and fascinating things with placental birth, I am in awe of the intelligence of our bodies and nature's way.

This has left me with some questions:
1. What, if any, is the relationship between the cord stopping pulsating and the birth of the placenta?

The cord stops pulsating when the baby's blood vessels from the cord shut down and fulfill the requirement to switch from fetal circulation to newborn circulation. The cord blood that is carried from the placenta to the baby is rich in stem cells (which is why you have for profit companies wanting to harvest them for a fee! Seems like they could be important for the baby!), iron and blood. The amount of blood the newborn misses out on with 'managed third stage' would be equivalent to major haemorrhage in a newborn if that blood was 'lost' after the cord was clamped. It is interesting to me that timing is everything. If it stays in the placenta because of active management, then that is ok, if it comes from the baby after that, it is not ok.

Sometimes, when the placenta is left attached, the placenta can be born and it is possible to still feel faint pulsation in the cord. The cessation of cord pulsation is not necessarily related to placental release from the uterine wall or the birth of the placenta. There are probably biochemical interrelationships and interactions that we are not sophisticated enough to know about or recognise in this process as yet. Most studies done on placentas after birth are done on placentas which come from actively managed third stages, so the natural process has not even begun to be mapped yet. As with placental implantation, there must be enzymatic and hormonal interactions at the cellular interfaces of the placental surface and the uterine wall when the process is allowed to follow the natural course of events, alongside the space reduction component following the birth of the baby. It is interesting that women who have birthed their placentas naturally and physiologically find that the post partum bleeding is substantially less than when they experienced actively managed third stages of labour.

2. How is a placenta birthed naturally ie do you have someone pulling on it or let it come out on its own etc?

The idea is to leave the process to do itself. My experience is that the placenta usually detaches quite soon after the birth of the baby and drops into the lower segment of the woman's uterus. The woman experiences this as pressure in her pelvis and rectum and, when she is upright, is easily able to push her placenta out. Women comment that it feels good to push the placenta out, they like the feeling of it travelling through their pelvis, cervix and vagina. It has no bones, so easily accommodates to the passage out. When women are engaged with their babies, skin to skin on their chests, helping the baby to find the breast and feeling really happy to see the baby, covered with nice warm blankets (or nice and warm in the bath) the hormonal flows generated by the process do the wondrous work of birthing the placenta. Disruptions can occur to this process, just like they can at any time in labour - being distracted by people coming or going, phone calls, discomfort etc so the aim is to keep the environment calm relaxed and conducive to normal physiological activity.

3. What is the obstetrician's role (private hospital) in birthing the placenta. Obviously if you need stitches, they have to wait until the placenta is birthed, but what apart from that?

Some obstetrician's suture whilst they wait for the signs of separation of the placenta, but most will immediately use active management of third stage - that is, administration of an oxytocic drug either intramuscularly or intravenously with the birth of the baby and then, after clamping and cutting the cord, applying supra pubic pressure to hold the uterus up and downward traction on the cord to facilitate the birth of the placenta. Then if there is a tear, the obstetricians or in public hospitals, midwives, will do whatever suturing is necessary. The midwives will check the placenta to make sure it is complete and that the cord has three cord vessels.

Hope this helps, warmly, Carolyn