The Delay for the Expulsion of the Placenta and the Asociated Risk of Haemorrhage

Hi! Here is the next chapter from my research on the placenta. Enjoy!

Even though most women will birth the placenta in less than thirty minutes following the baby's birth, a longer delay isn't automatically as dangerous as we might think. However, in a hospital setting, if a placenta takes more than thirty minutes to come out (sometimes even less), it'won't be long before the medical team starts to take some measures to force it out. They will usually start by giving some pitocin to the mother, and if that doesn't work, will start thinking about a manual extraction of the placenta. In her book Spiritual Midwifery, the legendary midwife Ina May Gaskin writes about a tolerated delay of one hour before we should start asking questions. She insists on the respect of the normal physiological process, and that we shouldn't try to rush things if everything seems to be fine. I have even heard the story of a woman who kept her placenta inside her for 15 hours without complications. It is really very difficult to evaluate the risk of haemorrhage related to the placenta, because the various manipulations by the medical team, some drugs given to the woman during labor and/or trying to force the placenta out faster may be the cause of these haemorrhages. Other possble causes are malnutrition and/or an malformation of the placenta. 




The two natural mechanisms for the expulstion of the placenta

Another important thing is to make sure the umbilical cord has finished pulsating before cutting and/or starting to think about the placenta. If the umbilical cord has stopped pulsating, it means the placenta has been emptied of the baby's blood and the risk of bleeding is lesssened. The fact that the placenta has been emptied also gives a signal to close the little capillaries that link the maternal and placental circulation, which could avoid haemorrhages. 

There are many gentle ways to encourage the placenta to come out if it takes to much time before doing a manual extraction, this manoeuver being the last resort, as it is very very painful and could trigger some heavy bleeding if done too early. First of all, if the first contact between the mother and baby is respected, the mother will produce high doses of the hormone oxytocin, which is usually sufficient to cause contractions that will force the placenta out. Then, skin-to-skin contact between mother and baby, on top of all it's other benefits, also makes the mother produce more oxytocin and helps the placenta out. Having the baby do a breast crawl, or softly massaging the uterus also helps the placenta to gently detach. Breastfeeding also causes the mother to produce oxytocin. If time flies, that all these things have been done and that there is still no sign of the placenta, we can encourage the mother to move, squat and try to push it out gently. Sometimes the placenta has come down but because of the mother's position is just sitting there in her vagina. If there is still no sign of the placenta, it is possible to inject some pitocin/syntocinon (synthetic oxytocin) which will cause contractions. NEVER try to pull on the cord, because it could break, or cause the placenta to come out in pieces and the consequences could be very very bad. 

It is also important to remember that even if we often call the placenta ''after-birth'' is is not an follow-up of the birth, it is entirely part of it. The hormones responsible for the birth on the placenta are the same as for the baby's birth. This would mean that it would be ideal and most beneficial to continue respecting the needs of the birthing mother and a calm and loving environnment to help the mother complete her birth peacefully. There is no need th stress her to try to birth the placenta as fast as possible. Respecting the calm and loving environment is also extremely beneficial to the first bonding between the mother and her baby. 

A manual extraction of the placenta and the uterine revision are really considered as a last resort. This manoeuver is not only extremely painful, there is a risk that it will trigger a haemorrhage. This manoeuver should only be done if 1- All the other methods to encourage the placenta out have failed 2- too much time has passed since the birth of the baby 3- there are signs that something might be wrong and the mother starts to worry and feel uneasy. 

It is important to keep in mind that maternal/feminine intuition is very strong. If the mother feels that everything is fine, there is no need to rush things. If she starts to ask questions and worry, there may be something wrong. 


Manual extraction of the placenta

In the case of a lotus baby, I don't think it changes anything regarding a uterine revision wether the baby is still attached or not to his placenta, as long as the cord has stopped pulsating. 

Another think that may cause a retention of the placenta would be a malformation, or an implantation too deep into the uterine wall (placenta accreta, percreta or increta). In these cases, it is vital that extreme care is taken because these are the most dangerous ones. 



Here are examples, in this picture above, of placenta accreta, increta and percreta. These three complications happen when the placenta is implanted too deep into the uterine wall, at different levels. The three names indicate the gravity level of the situation. 

I sincerely believe that many post-partum haemorrhages could be avoided with less medical manipulations. It isn't rare to hear stories from women who came close to dying because of too much interventions, manipulations, and an impatient medical staff. The list of experiences of this kind is unfortunately very long, and women do not always make it. Inductions and the administration of certain drugs during labor can also cause a retention of the placenta and augment the risk of post-partum haemorrhages. 

In case a woman bleeds too much, a little weird but efficient trick is to swallow a little chunk of placenta (usually a little cotyledon), coated with honey (for the taste). It stops the bleeding immeiately and causes the uterus to contract. It is a bizarre little trick, but a very useful one to know!

 I leave you with these few numbers that explain well the importance of respecting the natural process of the birth of the placenta. In a medical context, 9 to 10% of mothers haemorrrhage after the birth of the baby or the expulsion of the placenta. At The Farm (in Tennessee), the midwifery center where Ina May Gaskin works, the percentage of post-partum haemorrhage is less tha 2%.

Thank you and have a nice day!

Sources: 

Ina May's Guide to Childbirth, Ina May Gaskin
Spiritual Midwifery, Ina May Gaskin
Placenta, the Forgotten Chakra, Robin Lim
http://www.homebirth.org.uk/thirdstage.htm
http://www.uvp5.univ-paris5.fr/campus-gyneco-obst/cycle3/mto/poly/19000fra.asp
http://www.bellybelly.com.au/birth/natural-approach-to-labour
http://www-ulpmed.u-strasbg.fr/medecine/cours_en_ligne/e_cours/obstetrique/hemorragie_delivrance.pdf
http://www.babycentre.co.uk/pregnancy/labourandbirth/labour/managedthirdstageexpert/

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Comments

  1. Hi, if you don't mind I thought I'd share my story. 4th baby, UC, retained placenta. I feel length of labor to be a factor, though none of mine came out before the 1 hour mark w/out assistance. http://domesticfelicitations.blogspot.com/2013/06/its-girl-novel-length-birth-story.html

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    1. Thanks for your story!! Looks like you handled everything really well!!

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