birthing the placenta
Birth is not complete until the placenta is born. There is a constant dialogue between your baby and their placenta. It is your baby that tells the placenta when its function has been fulfilled.
The same environment that is optimal for birthing your baby is optimal for birthing the placenta. Keep the lighting dim; keep the room warm; and keep noise to a minimum. Revel in your new baby but don’t forget the work isn’t done.
During labor, your uterus changes. The cells that form your cervix pull up and away, forming a thick muscle at the top of the uterus called the fundus. By the time your baby emerges, the fundus is fully formed and powerful. If your waters have opened, your baby and placenta will be nestled next to each other with little to no space between them. After your baby is born, the flow of oxygen and blood continues as long as the umbilical cord remains intact.
PHYSIOLOGICAL PLACENTAL BIRTH - EXPECTANT MANAGEMENT
If labor and birth progressed without disruption, at this point there will be an interruption in your surges. Spend this time getting acquainted with your baby, investigating all their nooks and crannies. Perhaps you feel called to suction their airways with your mouth and give them a breath. Your baby’s blood continues to be transfused from the placenta into their own circulatory system. As this transfer takes place, blood rushes to your baby’s lungs. This begins the transition of oxygenation from placenta to lungs and the placenta knows its job is done.
The umbilical cord is a tube encasing (usually) one vein that carries oxygen-rich blood from the placenta to your baby and two arteries that carry blood back to the placenta with waste products like carbon dioxide. These blood vessels are protected by a substance called wharton’s jelly. After your baby is born and the umbilical cord comes in contact with air, the wharton’s jelly expands and helps clamp off the blood vessels. Stimulation of the cord by both the baby and birthing person touching it also helps this process.
When surges pick back up 5-15 minutes after your baby is born, they further constrict the blood vessels. The arteries - the vessels carrying blood back to the placenta - are the first ones to clamp off, preventing backflow into the placenta. As oxytocin drives the uterus to contract and shrink, blood vessels connecting to the uterine wall rupture and come away. This results in separation bleeding, a totally normal occurrence. A clot begins to form behind the placenta. If you adopt an upright position, this clot weighs down the placenta and encourages detachment. At this point you may feel the heaviness of the placenta in your vagina and feel the urge to push.
You have the option of helping your placenta by putting gentle traction on the cord yourself. By slightly spinning the cord as you pull, you are helping to break the suction over your cervix and ensure that the placenta emerges whole. You are not going to hurt yourself if you are the one to tug or guide your placenta out.
After the placenta has separated from the wall of the uterus, more clots form. Once the placenta is birthed, the uterus continues to contract and the placental site shrinks. A fine mesh begins to form over the placental site, slowing the flow of blood. Birth is complete.
MEDICAL PLACENTAL BIRTH - ACTIVE MANAGEMENT
If the natural flow of birth hormones was disrupted by something like pain medication, pitocin, or a provider, the birth of the placenta will likely be actively managed by your care providers. Often you will be given an injection of pitocin (synthetic oxytocin) shortly after your baby is born to keep your uterus contracting. The umbilical cord is also likely to be clamped prematurely, although you can advocate for that to be delayed. Your provider may put traction on the umbilical cord and ask you to push simultaneously in order to deliver the placenta. This will often be accompanied by aggressive fundal massage - your provider putting external pressure on your uterus, near your belly button, to further encourage your uterus to contract and shrink.
THE REALITY
Very often, a combination of expectant and active management is used during the birth of the placenta if you have chosen to birth with a medical professional. Most midwives who attend home births are able to administer pitocin injections if they feel it is necessary.
If it seems to be taking a long time for the placenta to be born, try and remember when was the last time you peed? The bladder sits directly below the uterus and if it’s full, it may be preventing effective contractions. If you are able, get a bedpan or some sort of bucket to sit over where you are instead of trying to get to the toilet to void your bladder. A few drops of peppermint essential oil in the bucket may help relax your urethra and allow urine to flow.
If you are wondering “how the heck will I know the placenta is ready to be born,” you’re not alone. Most of us know many of the signs that labor is imminent, but what about the placenta? One of the biggest clues is that your baby is moving and breathing. If they are taking breaths, then they are no longer receiving oxygen from the placenta. The umbilical cord will also lengthen as it empties. If surges have resumed and you are seeing some light bleeding or clots, it is likely time to birth your placenta.
I want to gently remind you that birth is bloody. And messy. But that is all as it should be. It is a natural function of our bodies. If you are feeling abnormally weak, dizzy, or unsteady, your body may not be tolerating the blood loss very well. Focus on eating nutrient-dense foods (oatmeal is a great place to start), resting, and hydrating with electrolytes.
Don’t leave the birth of your placenta to chance. Make sure to include your wishes in your birth plan. If you would like to discuss this more, please send me a message!
For more learning, check out this article by Dr. Rachel Reed and this podcast episode by Free Birth Society.
I am not a medical professional. The information in this post is not intended as medical advice. Please consult with your intuition and your healthcare provider about what is right for you and your family.
