The third stage of labour begins once the baby has been born, and ends with the birth of the placenta. Many women are now requesting a physiological (natural) birth of their placenta, especially following a natural birth. A safe physiological third stage requires oxytocin to be produced by the mother to stimulate the uterus to contract and expel the placenta. Generally, this requires:
- Natural birth: without medication to induce or augment (speed up) the labour, without an epidural, without forceps, vacuum or caesarean. So, in other words, a labour that starts on its own, progresses on its own, where the mother does not use medical forms of pain relief, and where she breathes out or pushes out her baby unassisted by forceps or a vacuum (or caesarean). This is because these natural processes prime the woman's body to release lots of oxytocin once the baby is born, to stimulate the uterus to contract to expel the placenta.
- An environment that supports oxytocin release: this would be a private, dark, calm, warm, quiet environment with a known and trusted care provider. Not the hustle and bustle of a busy delivery suite, but perhaps a water birth setting, home birth setting, or a birth centre setting.
- No distractions: the mother and baby should be left (but observed by a midwife) for uninterrupted skin-to-skin contact, bonding time and breastfeeding if the baby is ready for this.
- Leave the cord! No-one should be fiddling with the cord, checking pulsations or pulling on the cord. So long as the bleeding is not excessive, the woman should be left and observed.
In time, the placenta will emerge. Often the woman feels more contractions and an urge to push. If she is upright (eg squatting, sitting on the toilet, standing or kneeling) the placenta will come on its own, or perhaps with a gentle push. It can be supported as it emerges and collected into a bowl, ice cream container (sans ice cream) or other receptacle. The midwife would then check the placenta and membranes to ensure that they are complete.
Melissa Maimann is an eligible midwife in private practice in Sydney. One of the first eligible midwives in Australia, Melissa offers a range of care options for women. Visit Melissa's website to learn more about her services.