Birth of the Placenta - a physiological approach
Midwife Lennon showing the placenta to a big brother.
A Natural Birth of the Placenta vs.
A Managed Extraction
Tears of joy and congratulations meet your baby. The hard work is over and the fruit of your long pregnancy and exhausting labor is here. The small squeals of your squishy fresh baby fill your ears and the warmth of her skin saturates your chest. Finally, you can take a deep breath and relax, right?
Not quite…
The birth of your baby also brings the placental birth. The completion of the three stages of labor and birth and a very necessary step in all birth stories. Unfortunately, many women don’t know much about the placenta after birth.
In most circumstances, there are two ways for the placenta to be born. Either through direct management of a care provider or in a physiological way that falls in line with the natural order of birth.
The majority of women who have healthy births can also have a natural and spontaneous placenta delivery. So why does the medical model, which includes doctors and midwives for that matter, feel the need to intervene?
Today I want to explore managed placenta birth and discuss the research that supports a natural placenta birth.
The Placenta and Its Great Purpose
For a long time, we assumed that the mother’s body grew the placenta to support her baby. But we know this isn’t the case anymore. The placenta is the baby’s DNA, which means that the baby grows her own placenta! Through pregnancy, this incredible organ works in harmony with the mother’s and baby’s bodies to keep the baby nourished and alive.
Of course, there are instances of an unhealthy placenta but that is not the topic of today’s discussion. For the majority of women, their baby’s placenta attaches within her womb for all 9 months, only detaching after the baby is out and transitioned to life on Earth.
The Placenta After Birth
When your baby is born, he stays attached to you through his umbilical cord to the placenta. The placenta does not immediately stop nourishing your baby until he transitions to life on earth. Your baby cries more or less to constrict the blood vessels within the placenta to control how much blood he receives – wild, I know! ¹
Another critical thing to note is that up to 50% of your baby’s blood is still in the placenta at birth. When providers choose to manage the birth of the placenta, the baby is the one who suffers the loss of critical oxygenation and nutrition.
Yes, there is the argument that delayed cord clamping contributes to jaundice, but a bit of physiological jaundice in the early days is absolutely normal. Your baby needs her blood from the placenta and then in turn knows how to break it down through the normal processes of the body.¹
The perfect design leads to your baby needing more skin-to-skin contact with you to breastfeed and clear jaundice. The more skin-to-skin and suckling the baby does, the quicker your milk comes in, and the better the baby clears the extra blood cells she may not need anymore.
And the more blood that your baby takes in means there is less blood in the placenta, making it much easier to deliver. Unfortunately, many providers don’t trust physiological birth and placenta birth through to the end.
Managed Placenta Birth
The practice of managed placental birth, often heard as managed third stage, was widely adopted in the 1960s. Though it can be traced back to the 17th century when attending doctors didn’t want the bed linens to get messy – I’m not joking.¹
Managed placenta birth looks like this:
Once the baby is born, the baby’s cord is clamped and cut within seconds of birth
Then, the provider orders a shot of Pitocin (synthetic oxytocin) in the thigh or through the IV to move the process along
The provider keeps tension on the umbilical cord, awaiting contractions to bring the placenta out
When contractions come, the mother bares down to expel her placenta, while the provider has traction on the cord and guides the placenta out of the woman’s vagina
As the placenta is born, the provider twists it to get all the membranes out
The provider then touches the woman’s uterus to ensure that it is contractied– this is called fundal massage, which is also a standard of care to ensure the uterus stays contracted, but is unnecessary after a normal birth.¹
All in all, this process usually happens within minutes of the birth, and is very disruptive to not only the woman through pain and annoyance but also interrupts her own hormonal pathways.¹
The Research Behind Managed Third Stage
The research doesn’t fully support active management as a standard practice. One research body, Cochrane, describes that the studies don’t support every woman needing active management of her placental birth. ²
Of course, there are emergencies that need intervention. But does that need to apply to 95% of women who have healthy, normal births? I don’t think so.
And an even more interesting finding is that women who have a low risk of experiencing postpartum hemorrhage (PPH), and experience active management of their placental birth are 7-8x more likely to experience PPH. So, the tool that providers use to prevent the issue seems to be causing the issue. ³
But it doesn’t have to be this way… women are designed to grow and birth babies, why can’t they also birth their placentas with education, support, and the right cocktail of hormones?
Hormones of the Third Stage of Labor – Placental Birth
From the time your baby is born to the time your placenta comes out needs to be sacred, quiet, and warm. This creates the perfect environment for your hormones to do the rest of their job.
Oxytocin and endorphins explode in a powerful symphony of pleasure and joy, while your adrenaline and stress hormones relax as all the hard work comes to an end.
Resist the temptation to grab the phone, camera, or anyone that distracts you and your husband from this monumental moment.
The Internal Work of the Third Stage
Inside your body, your uterus is contracting, going from the height of your rib cage down to your belly button. This shears the placenta off the inner wall of the uterus so that it can be delivered.
But a physiological completion of the birth process is only accomplished with the right nurturing of the environment.
This is why it can be so challenging to have physiological placenta birth in the hospital, or even excited home/birth center because if the mother's hormone pathways are interrupted the process of placental birth is interrupted.
One mom reported, “It took one hour of labor for my baby to be born in the company of two wise elder women but TWO hours for my placenta to come! My husband came in with our son, our niece joined, a neighbor brought food…”
Can you see why her hormone pathways were interrupted?
But another mom said, “My labor was 27 hours long with my third baby. Start and stop the whole time. But once everything finally kicked, the house was dark and my support team was quiet. Once my son was born, his placenta came only 10 minutes after! All I had to do was snuggle my baby in the silence and listen to my body encourage me to stand to birth my own placenta.”
Our bodies are designed to do this, we need to create the environment to encourage the perfect design to work.
How To Deliver The Placenta at Home
So now that you know you can deliver your own placenta, how do you accomplish that? If the proper hormone cocktail needs to be released, what do you have to do to create the perfect environment?
Follow these steps…
Once your baby is born, keep the room dark, quiet, and warm
Try to avoid any interruptions to the halo of you, your baby, and your partner (yes, even your midwife. If baby is pink and wiggling, she can observe from a distance.)
Keep your baby on your chest, try to make eye contact with her, and talk to her
Once you feel contractions, find an upright position if you aren’t already upright – think sitting upright, squating, or sitting on the toilet
Gently bear down with contractions, if it feels right, guide the placenta out with your hand on the cord – this is not pulling just guiding
Birth your placenta into a container and keep it close to you and baby until you are ready to clamp and cut the cord – I like to wait till the cord is white, usually about an hour after birth
When you see these steps, it isn’t complicated! It just has to be encouraged and you, deserve a say in the matter.
Encourage the Physiological Birth of the Placenta with Midwife Lennon
For some women, physiological birth is a no-brainer. They have always felt called to give birth to their baby in the most natural way. But for others, it can require a lot of brain rewiring to encourage the proper hormonal pathways to work as they should.
Big brother helping to cut the cord after a physiological third stage.
When you choose a home birth midwife, you are taking the first step in supporting physiological labor, birth, and birth of the placenta.
As a small aside, there are times when a mother may make it through a very long and exhausting labor and come out on the other side saying “please just take care of the placenta for me”. So the midwife guides and facilitates the birth of the placenta. This is far different from medicalized and rushed placental birth.
Ultimately, you need to know your options. You know that there isn’t one way to birth your placenta. You have a voice and when you choose a home birth midwife, like myself, you will have a relationship that is built on trust and education. So you always have a choice in the way your labor and birth story find completion.
If you’re ready to take have a completely physiological labor, birth, and placental birth, reach out to me. I welcome all your questions and hesitations. I’d love to help you create the birth of your dreams.
References:
https://sarahbuckley.com/leaving-well-alone-a-natural-approach-to-the-third-stage-of-labour/
Active Versus Expectant Management For Women in The Third Stage of Labour (Review) Begley CM, Gyte GML, Devane D, McGuire W, Weeks A, Biesty LM
Holistic Physiological Care Compared With Active Management of the Third Stage of Labour for Women at Low Risk of Postpartum Haemorrhage: A Cohort Study Kathleen Fahy *, Carolyn Hastie, Andrew Bisits, Christine Marsh, Lurena Smith, Anne Saxton
