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The third stage of labour- leave well alone….

I was at a home birth only last week - the birth of a gorgeous girl after a five hour labour- and as is often the case at home births, the level of midwifery care was exemplary. The midwives- and there were two from fairly early on- were caring, quiet, attentive but entirely unobtrusive. Exactly the way good midwives should be. The first stage went smoothly and the mother coped admirably with movement, sound, good breathing and the use of water. And with wonderful guidance from the midwives, the second stage was also gentle despite the baby weighing in at over nine pounds. What then suprised me, was the rush to complete the third stage. As the mother had been slightly iron deficient during pregnancy I can only assume it was to avoid any risk at all of excessive blood loss, but after such a wonderful physiological first and second stage, it seemed out of keeping to me that the choice was taken to rush what can only be assumed would have been a very easy third stage. And yet this rush seems prevalent, even amongst those who otherwise support natural birth. It begs the question- when there is no emergency, whats the rush?Contrary to what a lot of people think, the birth is not over after the baby is born. In fact, as Dr Sarah Buckley suggests, in hormonal terms we are more in labour than ever during the third stage. The placenta needs to be born efficiently and in its entirety and the placental site needs closed down. Close proximity of mother and baby, or skin-to-skin is the perfect way to help this happen, as the baby’s touch and early suckling leads to reduced adrenaline as well as raised oxytocin levels and this induces the contractions that are necessary to detach and birth the placenta. As the birth is not over, keeping conditions as they were for the birth- dark, quiet and private- will also help this process.  Early separation of mother and child is not only very stressful for them both, but also reduces the fluidity of the hormonal interplay.This first hour after birth is also an extraordinary time, where the baby and mothers needs are entirely aligned and when they are completely primed for bodning, high on a cocktail of hormones that induce love, pleasure and attachment. Without due reason, to disturb this moment is arguably ensuring we lose some of this magic for no just cause.It is also the case that intervention in the third stage i.e active managment requires the umbilical cord to be cut prematurely or before it has stopped pulsating. Not only does this cut off the baby’s breathing back up plan, but it also ensures that the baby loses the blood trasferrance from the placenta which works out on average 100ml of extra blood ( this a third of their total blood volume) ensuring that their risk of anemia one month on is far higher.As in every part of the labour, we must start from the premise that we need do nothing, until a valid reason presents itself to intervene. ( In line with the first rule of medecine ‘Primum non nocere’ or  ’First do no harm’ )Mother nature has been finely tuned and highly evolved over millions of years. Many of the hormonal interplay is not fully understood, but that which is suggests mothers and babies are primed to be in a ceratin state and to behave in a certain way, and that it is to their overall ebnefit oif they do so. Tampering is usually counter-productive.As Sarah Buckley says in her fantastic book Gentle Birth, Gentle Mothering‘At a time when Mother Nature prescribes awe and ecstasy, we have injections, examinations, and clamping and pulling on the cord. Instead of body heat, skin-to-skin contact and the baby’s innate instinct to find the breast, we offer separation, wrapping and outside assistance to ‘attach’ the baby. When time should stand still for those eternal moments of first contact, as mother and baby fall deeply in love, we have haste to deliver the placenta and clean up for the next case.’

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