The Third Stage of Labor

By Midwifery Today

The Third Stage of Labor is a comprehensive volume, including insights regarding the umbilical cord, the placenta and natural approaches to this phase of birth. Contributors include Sarah J. Buckley, Gail Hart, Naoli Vinaver and Robin Lim.
Table of Contents
Chapter 1: “Placenta Accreta” by Marion Toepke McLean
Chapter 2: “The Care and Keeping of Placentas” by Jodi Selander
Chapter 3: “Cord Burning” by Kelly Dunn
Chapter 4: “Placenta Medicine: My Story” by Tiffany Rosenbrock
Chapter 5: “On Meconium at Home and Delayed Cord-cutting” by Naolí Vinaver
Chapter 6: “Placenta Rituals and Folklore from Around the World” by Sarah J. Buckley
Chapter 7: “Placentophagia: Stir-fry, Smoothie or Raw?” by Wendy Lubell-Snyder, with Tammi McKinley
Chapter 8: “Third Stage of Labor: Hands Off and Have Patience” by Christy Fiscer
Chapter 9: “The Bridge of Life: Options for Placentas” by Kelly Graff
Chapter 10: “The Color of Goldenrod” by Janice Marsh-Prelesnik
Chapter 11: “The Problem Is Induction, Not Meconium” by Gail Hart
Chapter 12: “Tsunami Midwives: Learning to Burn the Umbilical Cord” by Robin Lim, Harvest Rowena Alcock and Kelly Dunn
Chapter 13: “Velamentous Birth Story” by Jana Voelke Studelska
Chapter 14: “Knitted Noggins: Rethinking the Newborn Cap” by Nicole Deelah
Chapter 15: “A Natural Approach to the Third Stage of Labour: A Look at Early Cord Clamping, Cord Blood Harvesting and other Medical Interference” by Sarah J. Buckley

• Language: English
• Publisher: Midwifery Today
• Release date: Sep 13, 2012
• ISBN: 9781890446208

Midwifery Today

Midwifery Today publishes a quarterly print magazine for midwives and other birth professionals. We also put on two or more conferences each year, publish books, e-books and offer a free e-mail newsletter.

Book preview

The Third Stage of Labor

A Collection of Articles from Midwifery Today Magazine

Edited by

Nancy Halseide

Copyright 2012 Midwifery Today, Inc.

Published by Midwifery Today, Inc.

Smashwords Edition

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Cover photo by Natasha Hance

www.nhancephotography.com/

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Smashwords Edition, License Notes

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Disclaimer

This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

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Table of Contents

Chapter 1: Placenta Accreta by Marion Toepke McLean

Chapter 2: The Care and Keeping of Placentas by Jodi Selander

Chapter 3: Cord Burning by Kelly Dunn

Chapter 4: Placenta Medicine: My Story by Tiffany Rosenbrock

Chapter 5: On Meconium at Home and Delayed Cord-cutting by Naolí Vinaver

Chapter 6: Placenta Rituals and Folklore from Around the World by Sarah J. Buckley

Chapter 7: Placentophagia: Stir-fry, Smoothie or Raw? by Wendy Lubell-Snyder, with Tammi McKinley

Chapter 8: Third Stage of Labor: Hands Off and Have Patience by Christy Fiscer

Chapter 9: The Bridge of Life: Options for Placentas by Kelly Graff

Chapter 10: The Color of Goldenrod by Janice Marsh-Prelesnik

Chapter 11: The Problem Is Induction, Not Meconium by Gail Hart

Chapter 12: Tsunami Midwives: Learning to Burn the Umbilical Cord by Robin Lim, Harvest Rowena Alcock and Kelly Dunn

Chapter 13: Velamentous Birth Story by Jana Voelke Studelska

Chapter 14: Knitted Noggins: Rethinking the Newborn Cap by Nicole Deelah

Chapter 15: A Natural Approach to the Third Stage of Labour: A Look at Early Cord Clamping, Cord Blood Harvesting and other Medical Interference by Sarah J. Buckley

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CHAPTER 1

Placenta Accreta

by Marion Toepke McLean

Copyright 2011 Midwifery Today, Inc. All rights reserved.

Editor’s note: This article first appeared in Midwifery Today, Issue 97, Spring 2011.

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The baby is born successfully and begins to nurse on its own. The delighted family crowds around. The midwife has her eye on the cord, watching for signs of placental separation: the lengthening of the cord, the little gush of blood. From time to time she gently and unobtrusively palpates the fundus, checking for firmness and for a rise in fundal height. She does not massage or press down on the fundus. She has not pulled on the cord, nor has she made any attempt to deliver the placenta. The vital signs are normal. So far, so good!

If she decides to cut the cord, the midwife may then drain the placenta. This means that the placental blood, and not any maternal blood, drains from the placenta, decompressing it. This may cause the placenta to deliver, if it is indeed a normally implanted placenta.

The midwife may now put on sterile gloves and examine the introitus and the birth canal for tears. To learn if the placenta is separated, she may follow the cord up inside. If it has separated, she will probably feel the smooth fetal surface of the placenta, with its bulging blood vessels, protruding from the cervix. Alternately, she may feel the liver-like maternal surface of the placenta coming through the cervical os.

But perhaps she feels neither of the above. No sign of placental separation and no bleeding except what may come from birth canal lacerations. These can be signs of placenta accreta. If this is the case, the midwife will be happy if she remembers the words of poet Alan Ginsberg, It’s never too late to do nothing at all.

Placenta accreta is abnormal adherence of the placenta to the wall of the uterus. Instead of forming within the endometrial lining of the uterus, it has grown down into the muscular wall of the uterus, sometimes even through the muscle. The whole placenta may be in-grown, or only a portion. If the placenta is attached to the surface of the myometrium, the term accreta pertains; if the placenta is grown into the muscle, it is called an increta; and if it has grown through the muscle and into other organs, it is called a placenta percreta. The abnormally adherent placenta does not separate from the uterine wall spontaneously, and attempts to remove it may lead to torrential hemorrhage. Placenta accreta in all its forms is a persistent cause of maternal death.

Removal of a retained placenta is best undertaken in the operating room with an intravenous line in place and blood transfusion available. Even with those precautions, it may be impossible to stop hemorrhaging without removing the uterus. As a hysterectomy can entail major blood loss, if significant bleeding has already taken place when the decision to remove the uterus is made, the life of the mother may still be lost or her health compromised.

It is for this reason that researchers at the University of Utah Medical School recommend delivery by cesarean hysterectomy without placental removal in cases in which placenta accreta has been identified by prenatal ultrasound and/or MRI (Eller et al. 2009). Life-threatening blood loss is prevented when placental separation is not attempted. In the researchers’ series of 76 cases of placenta accreta, maternal complications were reduced to 36%. When placental delivery was attempted before hysterectomy, maternal complications occurred 67% of the time.

There is, however, a valid, conservative treatment which can preserve the woman’s fertility, as revealed by research from France and Australia. The placenta is simply left in place, to reabsorb.

Dr. L. Sentilhes, of the department of obstetrics and gynecology in Angers, France, along with colleagues throughout France, published three articles in 2010 relating to a retrospective, multi-center study of 167 patients with placenta accreta between 1993 and 2007 (Sentilhes et al. 2010). In these cases, the placenta was left in situ unless hemorrhaging occurred, with no attempt being made to remove it forcefully. Eighteen of the women required primary hysterectomy and another 18, delayed hysterectomy. The rest of the women, numbering 131, experienced resorption of the placenta and recovered successfully. Of the 27 women who wanted more children, 21 delivered healthy children of 34 weeks gestation or more by the end of the study, and three were trying to conceive.

The researchers concluded: "In cases of placenta accreta, the patient and her partner must be involved in decision making…It seems reasonable to propose a cesarean hysterectomy to multiparous patients with no desire of future pregnancy. In young women who want the option of future pregnancy and who agree to close follow-up monitoring, conservative treatment should be preferred. When placenta accreta is diagnosed during delivery, the two options remain possible only if attempts at removal of the placenta are stopped before the occurrence of severe postpartum hemorrhage. In cases of placenta