DOULA+INFLUENCER+ADVOCATE

Photograph by Kayla Grey

Physiological Birth or Active Management

Let’s talk about the third stage of Labour because a mothers work is never done.  This stage can take anywhere from 5-20 minutes, sometimes longer.  

But what we see in hospitals settings is far from a physiological birth of the placenta.  What we generally see and are accustomed to is active management of the placenta.  

Let’s explore the differences between the 2!

A natural management of the third stage would be waiting for the placenta to detach and drop down on its own without anyone pulling in the cord, given that mother and baby are doing well. We do not rush, we just wait.  There are things we can do to help the placenta come along.

It’s vital that at this stage we lower mommy’s adrenaline level and increase Oxytocin to its peak level by:
✅having mommy hold her baby uninterrupted with skin to skin contact
✅initiating breastfeeding and breast crawl
✅lighting lowered
✅warm room
✅minimal outside sounds so baby can hear parents clearly
✅baby should stay with parents if all is well and routine exams should wait

All of these things bring Oxytocin to its peak to strengthen uterine contractions and shrink the uterus to aid in separating the placenta from the uterus.

Mother Nature is actively preventing hemorrhage, continues the delicate dance of hormones, bonds you to your baby, ensuring your care and protection and survival of your baby.

Physiological Birth Of The Placenta

 All of these things above are largely missing in a modern hospital environment which actually adds risk to postpartum hemorrhages.  How? 


Well, let’s now talk about how active management of the third stage is done.


Active management of the third stage involves giving a drug (a uterotonic, like Pitocin) to contract the uterus, clamping the cord early (usually before, alongside, or immediately after giving the uterotonic), and traction is applied to the cord with counter-pressure on the uterus to deliver the placenta (controlled cord traction). Active management was introduced to try to reduce severe blood loss at birth.  This is a major cause of women dying in low-income countries where women are more likely to be poorly nourished, anaemic, have little access to clean water and have infectious diseases.  In high-income countries, severe bleeding occurs much less often, yet active management has become standard practice in many countries and it’s what we are accustomed to.


During active management in a hospital, we do everything that increases adrenaline and in turn increases postpartum hemorrhages:
❌unnecessary inductions causes the uterus to become overly exhausted and will have a difficult time contracting strong enough to release the placenta and shrink
❌sounds and lights are up to the max
❌strangers are vigorously rubbing baby and disturbing the bond
❌baby gets wrapped in blankets that disturb the skin to skin contact
❌the cord is pulled on immediately and forced to detach, even if it’s not ready
❌the umbilical cord can snap, leaving the placenta still attached and mommy will have to undergo surgery to manually remove the placenta
❌forceful removal can cause postpartum hemorrhages because the placenta was not ready


NOT HAVING PATIENCE CAN BE DANGEROUS!  THIS FORCEFUL SEPARATION CAN CAUSE DEEP WOUNDS, EXCESSIVE BLEEDING, BE EXTREMELY PAINFUL, MAY NOW NEED TO BE MANUALLY REMOVED AND CAUSE INFECTION TO THE UTERUS!




Active Management Of Placenta

Photograph by The Joyful Tree

 

This photograph is of an actively managed  placenta that was forcefully removed  when it was not ready, due to lack of patience which caused the umbilical cord to break fully off of the placenta  and causing it to tear.  


THIS CAN CAUSE MANY PROBLEMS!


A woman can choose to have a physiological/natural third stage, or an “actively managed” one.  It is essential that you discuss with the health professionals who will be assisting you in the birth of your baby the specific ways that you want to birth your placenta.


Through and through, every aspect and stage of birth needs to be respected.  Rushing things can often be dangerous for the mother and her baby