There has been a lot of evidence lately supporting the benefits of delayed cord clamping and this may have you considering a physiological third stage as part of your Birth Preferences.
As a natural birth educator, I’m excited by every step our culture takes to remember birth is a normal, everyday physiological event that your body is designed to do naturally. But recent conversations have me realising that, in educating women the benefits of requesting natural processes, the importance of also ensuring your birth attendants are skilled and comfortable in supporting Natural.
Recently I’ve heard stories about women who’ve had normal spontaneous (not induced) labours and births and then big post partum haemorrhages (PPH) after a physiological third stage in hospital. One woman needed a transfusion of several units of blood and was transferred to Melbourne for intensive care.
These conversations prompted me to ask questions and I want to share with you what I learned in the hope of avoiding similar stories. My hope is to provide you with the information needed to safely support your choice to have a physiological third stage if that is what is important to you.
This is because these conversations have highlighted a huge red flag issue for women choosing a physiological third stage in an environment not familiar with supporting natural processes (i.e. hospital).
SO WHAT IS PHYSIOLOGICAL THIRD STAGE?
Third stage labor is the time immediately after your baby is born until the placenta and membranes have been born.
A physiological third stage is to allow the third stage to happen naturally, without the use of oxytocic drugs. The cord is left unclamped and uncut until it stops pulsating or until the placenta is born. The placenta is birthed by your own efforts and may take a significantly longer time then when active management is used.
Active management of third stage is the term given to the medical management of third stage. This usually involves being given an intramuscular injection of an oxytocic drug (syntocinon) immediately as your baby is being born; clamping and cutting the umbilical cord immediately after birth; and applying gentle traction to the end of the cord to birth the placenta reasonably quickly.
The risk associated with third stage is post partum haemorrhage (PPH). Active management has evolved as the reported best practice to reduce this risk, and in light of the stories of women who’ve opted for a physiological third stage and then had a PPH, this would seem to support this practice.
However, upon further questioning of these stories it is not the physiological third stage that increased the risk of PPH (nature did not intend for women to bleed to death after birth!) but the management of physiological third stage by staff not trained in supporting normal, natural processes.
In such a situation advising women the benefits of choosing physiological third stage may become dangerous if their care providers do not have the appropriate training and understanding of normal physiological childbirth: a situation that represents the vast majority of hospital based midwives, obstetricians and doctors.
To best illustrate this point, let me share with you a story…
My client had opted to have a physiological third stage. The labor and birth had gone beautifully.
As the baby is being born the doctor complies with the mothers wishes of a ‘physiological third stage’ and not given the standard injection of syntocinon.
BUT THEN almost as soon as the baby is born the doctor reverts to standard practice and within minutes of birth – without syntocinon – starts to apply cord traction. This means the doctor is pulling on the umbilical cord to try and hasten the delivery of the placenta. This is a permitable practice with active management as syntocinon is a powerful oxytocic drug that strongly causes the uterus to contract and the placenta to sheer away from the walls of the uterus within minutes.
Without administering this drug, applying traction to the cord is downright DANGEROUS.
Physiological third stage requires TIME for the mother’s natural oxytocin hormones to produce the uterine contractions that help the placenta come away.
How long this takes is dependent on many factors including: a calm and quiet atmosphere; privacy; the undisturbed and unhurried ability to enjoy skin-to-skin contact with baby and eye gazing; taking time to initiate breastfeeding; time-out to recover from the activity of birthing; and the ability to adopt the position most comfortable.
It is estimated normal physiological third stage may take anywhere between 20mins to 2 hours.
The mother started hemorrhaging. The doctor administered syntocinon. The mother continued to weaken and the bleeding did not stop. Eventually she was admitted for surgery where it turned out she had retained placenta. She suffered massive hemorrhaging and required several litres of blood transfusion.
Sadly, her story will be recorded as a PPH because the mother refused syntocinon, and seen as further justification for the active management of third stage rather then the truth of another birth story where no one is held accountable for birth malpractice. This kind of malpractice due to ignorance of Natures processes is not an isolated incident and is a big concern for women requesting physiological third stage in hospital.
I wholeheartedly believe physiological third stage is the best practice for both mother and baby in an environment that supports normal physiological labor. I’d love to be able to say that for all women but that may not be so.
That’s not to say you can’t safely experience physiological third stage in a hospital setting, but if this is your preference please ensure your care providers understand how to support this practice.
Please don’t assume that this is the case!
Remember, normal physiological childbirth is almost never witnessed in hospital.
Understand that it may be up to YOU to educate your care givers and provide them with information on how to work with Nature. This means ensuring a mandatory hands-off, do not interfere approach and respect for the body’s timing.
“Choosing to forego preventative oxytocics, to clamp late (if at all), and to deliver the placenta by our own effort all require forethought, commitment, and that we choose birth attendants that are comfortable and experienced with these choices.
A natural third stage is more than this, however – we must ensure respect for the emotional and hormonal processes of both mother and baby, remembering how unique this time is. Michel Odent stresses the importance of not interrupting, even with words, and believes that ideally the new mother feels unobserved and uninhibited in the first encounter with her baby. This level of non-interference is uncommon, even in home and birth centre settings.”
– Dr Sarah J Buckley, Gentle Birth, Gentle Mothering
Please click here for excellent research and scientifically backed information about the benefits of a natural third stage.
Did you know that placenta is rich in the hormone heparin as well as Vitamin K that helps stop bleeding? Thousands of years of evolution didn’t get it wrong! Traditional midwives know to encourage women to bite on a small piece of placenta cord or membrane after birth to aid and prevent post partum haemorrhage. Find out more about the benefits of placenta (without the squeamishness) with Placenta Encapsulation.