WHAT IS THE THIRD STAGE?
The third stage is defined by the birth of the placenta shortly after the baby is born. During the birth of the placenta you will experience uterine contractions as the placenta separates from the uterus wall, moves through the cervix and, when it has moved down far enough, you will work with a final contraction to push and get the placenta the rest of the way out.
As third stage often gets little mention in pregnancy books, lets discuss how protecting the third stage environment, as we do with our birthing environment, may encourage a faster, natural delivery of the placenta, reducing the need for intervention or an ‘actively managed’ third stage.
(noun) A flattened circular organ in the uterus of pregnant eutherian mammals, nourishing and maintaining the foetus through the umbilical cord.
When you become pregnant, your uterus contains just a cluster of cells. Half of those go on to become your baby and the other half become the placenta. The placenta is a temporary organ that is attached to the wall of the uterus throughout pregnancy. It performs many functions including providing nutrients, oxygen and protection against harmful bacteria via the umbilical cord. More or less anything you consume will pass to your baby via the placenta, which is why toxins should be kept to a minimum during pregnancy.
The placenta also disposes of the baby’s waste, such as carbon dioxide, which passes back up the umbilical cord to your blood stream where your body disposes of it.
Put simply, the placenta serves as the baby’s lifeline during the 40ish weeks in the womb. It is amazing and should be recognised for it’s vital role!
PHYSIOLOGY OF THE THIRD STAGE
During pregnancy, most women often spend lots of time making plans for their birth and deciding what birth preferences suit them most, but often the third stage is forgotten about or generally not given much thought. In many hospitals now, it is routine to have an actively managed third stage which means as your baby is born you are given an intramuscular injection of a synthetic form of the naturally occurring hormone oxytocin. Some women may not have a preference whether or not they have an actively managed or a physiological (natural) third stage (see below for pros and cons) but for those that do, its good to know what things could help the third stage progress so that you are able to protect the ‘golden hour’ and deliver the placenta naturally.
As mentioned above, oxytocin continues to play a huge role during the third stage. Oxytocin is a very shy hormone and there are things within the environment that can cause adrenaline to spike and for oxytocin levels to decrease, which will slow uterine contractions. In order to keep a good hormonal balance it is important to continue to protect the birthing space.
BREASTFEEDING AND SKIN-TO-SKIN
Initialising that first feed encourages the release of oxytocin, but if your baby doesn’t show signs of wanting to breastfeed straight away, just holding her close to your chest will have a similar effect.
Maintaining the environment of the birth space with low lights, warmth and no observers encourages the mother to feel comfortable and, in turn, speeds up the duration of a natural third stage.
- Encourages a calm, quiet and undisturbed atmosphere allowing you to be present with your new baby.
- Allows time for bonding through breastfeeding and skin-to-skin.
- You can adopt different positions and move instinctively with your body.
- Physiological management is less likely if labour has been induced or required pain management and intervention, as the administration of synthetic oxytocin will inhibit your ability to produce your own oxytocin.
- It can take some time for the placenta to deliver naturally (time which is less likely to be allowed for in a hospital setting) and just as with earlier phases of labour emotional and environmental factors could delay it; such as a change in lighting, temperature or a feeling of being observed.
- The process is quicker than a physiological third stage, lasting 5-15 minutes. After synthetic oxytocin is administered the placenta needs to be delivered quickly to avoid retained placenta.
- In the event of the placenta taking a long time to deliver, it will have to be removed manually under general anaesthetic.
- You may experience discomfort when the midwife performs the controlled cord traction (CCT), which is performed after you receive synthetic oxytocin via an intramuscular injection. A CCT involves the midwife placing her hand on your abdomen so that she can feel when the uterus contacts. She will then pull gently on the cord whilst applying pressure to the uterus.
- It can be uncomfortable as you will most likely be asked to lay on the bed in a semi-reclined position so that the midwife can carry out the CCT.
DELAYED CORD CLAMPING
Another thing very injurious to the child is the tying and the cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta which ought to have been in the child.Darwin, 1801
For many years immediate clamping of the umbilical cord (between 10-15 seconds) after birth has been standard practice. There is now evidence to suggest that it is beneficial to allow the cord to fully pulsate before clamping for the following reasons:
- The cord and placenta hold up to 30% of the baby’s blood. Allowing the cord to pulsate means the blood can flow through it and aid the baby’s lung expansion. When the cord is clamped immediately, blood has to be “borrowed” from the rest of the baby’s circulation in order for the lungs to be fully functioning (even though the baby’s other organs also need blood to start functioning).
- As the baby receives the full amount of blood from the placenta, iron levels are higher and it reduces the chances of anaemia. Anaemia in infants can go on to effect the development of the nervous system and brain development.
- Delaying the clamping of the cord allows the baby to receive up to a billion more stem cells than if it were to be clamped immediately after birth. Stem cells have wonderful healing qualities.
- Birth weight will be increased and blood pressure stabilised after delayed cord clamping.
- If resuscitation is required after the baby is born it is beneficial to leave the cord unclamped as it assists in oxygenating the lungs.
- It has been suggested that the baby’s cord stump will take less time to heal and ‘drop off’ after delayed cord clamping.
BENEFITTING FROM YOUR PLACENTA
The placenta is becoming increasingly recognised for the important role it plays in post-birth healing. According to the Placenta Remedies Network “during and after a normal vaginal delivery (including post-natal bleeding) a new mother will lose between 1/8 to 1/10 of her body’s blood supply. Losing a large amount of iron so quickly can cause anaemia, leaving a new mum feeling tired, faint and exhausted. The blood needs high supplies of iron to carry oxygen to the cells. Low supplies of oxygen leave your cells starving and less able to heal after trauma.”
Consuming your placenta, which is rich in iron, restores your iron levels reducing fatigue. Blood loss during the postnatal period stems from the wound in the uterus where the placenta was attached and can last for 3-6 weeks. Consuming your placenta can reduce postpartum blood loss to 5-10 days because the placenta is full of stem cells and growth factors, which play a huge role in healing the wound in your uterus. Your placenta also aids the replenishment of vitamins E and B6, is rich in hormones such as oxytocin and corticotropin and immune boosting proteins. In addition to reducing the duration of postpartum blood loss, all of the wonderful nutrients in your placenta contribute to encouraging a plentiful milk supply, boosting energy levels and balancing hormone levels reducing the chances of “baby blues” and postnatal depression.
Your placenta can be made into numerous different remedies which include:
- Raw placenta smoothie
- Placenta Encapsulation
- Homeopathic Remedies
- Creams or balms
MAKING A THIRD STAGE PLAN
It can be very beneficial to include your wishes for the third stage in your birth plan. You have the right to an empowered third stage too. Things to consider for a physiological third stage:
- State that you’d like to try for a natural placenta delivery. Keep the birth space protected – dimly lit, comfortable temperature.
- Allow time for the cord to finish pulsating before clamping.
- Immediate skin-to-skin with your new baby.
- Put your baby to your breast. Try to initiate the first feed. Keep things calm and undisturbed.
- State if you want to wait for newborn checks and weighing.
- Don’t be afraid to ask to see the placenta once it has been delivered. If you want to take it home to benefit from placenta remedies ensure you state this in your birth plan and have your birth partner discuss plans with your midwife upon arrival.