Student supervisor wrote:
Has anyone been involved in the development of third stage guidelines.
As a student supervisor of midwives I have ending up volunteering myself
for this task and need some guidance and info. Anything would be good.
Jessica (midwife) wrote:
I get the woman into squatting as soon as possible- usually 4 minutes
after birth and she pushes it out in squatting.
This is usually on the floor, so it is stable.. I wouldn’t do it on a bed.
Gloria wrote: I can’t believe that a midwife would be getting a postpartum
woman into a squatting position and expecting her placenta out 4 minutes after birth.
This is a recipe for hemorrhage and prolapsed uterus!
If we need to have a time line for the placenta, it would be 30 minutes. The mother
has just given birth—she needs to luxuriate in the glorious feeling of
conquest, peace and joy at meeting her long-awaited newborn. Her uterus
responds to all the oxytocin love hormones by continuing to clamp down
around the placenta and safely bring it away from the uterine wall.
Here’s something I wrote on the subject that was published in Midwifery Today (Issue 72, Winter 2004):
The 30-Minute Third Stage
by Gloria Lemay
I teach my student midwives in Canada the “30-Minute Third Stage.” This
means we don’t anticipate that the placenta will be pushed out for a
full 30 minutes after the birth of the baby. The “mood” of the birth is
maintained in the room, that is, no phone calls, no excited chatter, no
disturbance of the mother, lights low, mother and baby wrapped warmly
together skin-to-skin. We offer a warm herbal tea mixture with a
drinking straw and tell the mother, “This will help your placenta come
out smoothly, all in one piece.”
We don’t disturb the attachment that happens naturally or push sucking
at the breast. Many babies don’t want to feed right away, and usually
the family wants to enjoy undisturbed time to get to know each other.
More than sucking, it is the skin contact and little (or big) noises of
the newborn that make the uterus contract powerfully after the birth.
Almost one hundred percent of women look at the attendant at the
30-minute point and say, “I’m having more cramps,” “I’m feeling
pressure,” “Should it be hurting in my belly now?” or some other thing
that tells us the placenta is ready to come out.
We don’t look for lengthening of the cord, separation gush or any of the
usual observations. Our observations in the first hour after birth are,
“Is the mother bright-eyed?” “Does her face look beautiful and radiant?”
“Is she focused on her baby and enjoying this time with her child?” A
woman who is bleeding too heavily will look worried, have a lack of skin
sheen and may be asking someone else to hold her baby. These rare
occurrences indicate something is wrong and the mother needs immediate
attention either to stop bleeding or increase her blood sugars. There is
no need to pester the bright-eyed, radiant mother by fussing around with
pulse checks and BP readings. No routine Pitocin. With a stable mother,
there is no rush.
After the 30-minute point, most women push the placenta out by
themselves or with light traction. We have seen some third stages that
take more than two hours, but these are very rare. I have had years of
practice using this method and have attended hundreds of births, with
less than a 1% hemorrhage rate. Unfortunately, many midwives in North
America have the idea that the placenta should be out in 5–15 minutes.
In my view, this is a recipe for disaster.
Added Dec. 2012 Some midwives in Australia published research which supports my methods.
Added March 2013: This link will show you what I read that made me start doing 30 minutes of waiting after birth before even mentioning the placenta