So it feels like I’m banging on about the Placenta right? Well, yes I am - but with good reason! Did you know that the majority of women in Australia go through their whole pregnancy not discussing options for the third stage of labour? If it is brushed over in a quick talk, care providers can also make statements of “hospital policy” instead of going through your options. So here we are… let’s fill some gaps in information, shall we?

Physiological delivery - what happens for mum & bub

When a mother and baby are uninterrupted and given time after birth, the baby can start to bond with mum in skin to skin and starts to breathe air. As the baby’s oxygen levels increase, its lungs are activated and the placenta gets the message that its job is nearly done. Blood vessels in the baby’s lungs open up and are filled with blood from the placenta. The two arteries that send blood back to the placenta now start to constrict so that the blood is on a one way track directly to your baby. With patience, and a safe and calm environment, the baby will begin to attempt breastfeeding and this will trigger hormones that start a natural detaching of the placenta from the wall of the womb with a clot forming behind it. The mother’s body might have contractions or urges to push, and the placenta will come sliding out like a slab of jelly, sometimes with the help of a cough or standing up (gravity!). Research shows that the best prevention of a postpartum haemorrhage in a physiological birth is having the baby on the mother’s skin to keep the hormones flowing. It can take up to an hour or more for the placenta to detach, so asking for extra time would be pretty vital in choosing this option.

Active Management (usually hospital preferrence)

Active management is when a uterotonic (a synthetic version of oxytocin usually) called syntocinon is injected into the mother so that contractions start to release the placenta. Unless there is an immediate need to control a haemorrhage, this can be done at any time after the baby’s birth, meaning that you can wait for the full volume of blood to reach bub before it’s administered. This is the same drug that is given for a chemical induction, in which case another drug may need to be administered called ergometrine. This one can make mum feel a little worse for wear, so it’s important to ask which one will be administered if you choose this route.

Postpartum Haemorrhage, Breastfeeding & other things to consider

Even though the World Health Organisation recommends uterotonic management of the placenta in all births worldwide, there is research emerging that in a physiological birth (intervention & induction free) in low risk women, PPH is more common if the uterotonic is administered. Research is also well established that breastfeeding rates are affected if syntocinon is administered to mums at ANY point during labour and birth. Of course, hormonal gaps can always be filled with skin-to-skin - and it’s important to have this knowledge before you go into labour so that you can plan ahead for the outcome you want.

I want a physiological placental birth, now what?

The first thing to do is chat with your care provider during pregnancy. While most will be fine with it, or at the very least, having a “wait and see” approach, some OB’s (while not ethical) may choose to discontinue treatment if you choose a physiological placental birth, so it’s important to have this conversation during pregnancy if it’s something you really want. It’s really important to also have your birth space protected during the golden moments after birth, as it will be the safest way for you to birth your placenta. Keeping the room dark, quiet and relaxed, keeping your baby on you, and keeping everyone unnecessary out of the room (including phone calls to the outside world!) will allow your hormones to continue on their natural trajectory and work efficiently. There is plenty of time to announce your baby’s birth, and detaching from the bubble of hormones can stop your hormones from working. The birth is not “done” until the placenta is out - so take that time to soak up your new baby’s smells and sounds. If your birth team know that you want a physiological third stage they will ensure that your space is held until after you birth your placenta - one of the perks of having a doula in the hospital!

After looking at the benefits and risks of both medical management and physiological birth of your placenta or the “third stage”, you can now make an informed decision. Having these conversations with your partner and birth team during pregnancy is not only empowering for you but can help everyone feel involved and invested in the outcomes of your birth. So go ahead and keep researching and resolving all of your birth choices, mapping out a plan that you feel comfortable with. What else should you be discussing with your care provider before employing them? Stay tuned for the next blog!

Resources & further research:

Midwife Thinking - An Actively Managed Placental Birth Might Be the Best Option for Most Women

Sara Wickham - Can I have a Natural Placental Birth After Induction

My name is Brittney Blakeney and I am a Pregnancy, Childbirth and Postpartum Doula, with an emphasis on education and preparation for your birth experience as a woman and mother.

My job is to give you the most up to date research so that you can make decisions with confidence, and to give you the tools, techniques and encouragement to feel calm, safe and supported during your pregnancy, birth and postpartum journey. I aim to create villages around women to ensure they feel strong, supported and listened to as they transition to their new role.

If you don’t want to miss out on any new morsels of info, subscribe to my newsletter to be notified of the latest blogs. I am based NOR in Perth, and can be contacted by email at doula@brittneyblakeney.com.au or head to my Insta to send a direct message.

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