The Third Stage of Labor

Newborn in mother's armsYour beautiful baby has just been born and placed, slowly and gently, on your stomach. Flesh-to-flesh contact will probably feel just right to you. Skin contact will feel good to your baby, too, and keep her warm. You may want to have a blanket placed over both of you and a hat put on your newborn’s head to cut down on heat loss.

Now is your chance to touch and gaze at this amazing new life. Babies are incredibly alert directly after birth. You may find her staring at you with wide-open eyes.

If you place the baby on or near your breast, you will observe her beginning to search for the nipple. Some babies do this right away. Others take a bit longer, so be patient and follow your baby’s lead. Once the baby begins to move her mouth or lick your nipple, try to help her to latch on. If you feel unsure about this (and many new mothers do), ask your midwife to help you, or ask the nurse to call a lactation specialist if you are in a hospital.

Clamping the Umbilical Cord
In standard hospital births, the umbilical cord is clamped in two places right away, usually within 1 minute of birth, and then cut between the clamps. More recently, however, many practitioners have begun to perform later cord-clamping.

You will notice, when the baby is born, that the umbilical cord is still pulsing with the movement of blood that is flowing to the baby. Proponents of late cord-cutting think it best to wait until the cord is no longer pulsing, allowing all of this blood to go to the infant, and then to cut it.

If a mother is Rh-negative and has an Rh-positive baby, there is an especially good case for leaving the cord until blood has stopped pulsing. This will reduce chances that the Rh-positive baby’s blood still in the placenta will backwash into the mother’s bloodstream, causing her to develop antibodies that can complicate future pregnancies.

Those who still prefer early cord-clamping sometimes state that this will cut down on an infant’s blood bilirubin levels, thus reducing his chances of having newborn jaundice. In fact, studies show the difference in bilirubin levels between early and late cord-clamping infants is not significant.

Sometimes, later cord-clamping is not possible because some babies have a short cord. Other babies are born with the cord wrapped around their necks, so that it is necessary to cut it right away.

If your partner would like to be the one who cuts the cord, arrange for this with your birth attendant ahead of time.

Birthing the Placenta
Once the baby is born, your uterus continues to contract, although you may not feel it happening. The placenta separates from the uterine wall and is expelled. There are two ways of handling the birth of the placenta.

One is the practice of active management. This means that the practitioner takes a proactive stance and tries to hurry things along. The cord is cut immediately, and oxytocin, often in the form of pitocin, is administered to create contractions that will expel the placenta. Sometimes the birth attendant will pull on the cord and ask you to bear down to help it out.

The other method is one of watchful waiting, allowing the placenta to come out naturally. Sometimes gravity can help with this, if the woman sits up or squats for a few moments. Nursing the baby can also help because breastfeeding encourages the production of the hormone oxytocin, which causes the uterus to contract.

The average length of time for the third stage of labor in homebirths is about 20 minutes. In hospitals, it is closer to 5 minutes.

Creating some kind of ceremonial treatment for the placenta can be a wonderful way to give thanks for the process of nurturing that has been so much a part of your life for the past nine months. You might bury the placenta under a favorite tress, or in your garden. For some women, it is enough to just say a silent prayer of gratitude, or reflect, for a moment, about the amazing journey she has been on.

The Moments after Birth
Breastfeeding and skin-to-skin and eye-to-eye contact with your baby enhance the production of oxytocin, a hormone that wards off postpartum depression and ensures continued uterine contractions that prevent hemorrhage and speed healing. Beta-endorphins, neurotransmitters that accelerate the intense bonding experience between mother and baby, peak in the mother 20 minutes after the birth and are present in breastmilk.

Right after birth, your uterus will be about the size of a grapefruit. You will experience several strong contractions for the first 24 hours after birth as your uterus shrinks. Over the next six weeks, your uterus will return to its normal, pear-like size. The place where the placenta was attached to the uterus will heal completely, leaving no scar tissue. As your uterus heals over the next six weeks, you will have a bloody discharge that is bright red in the beginning and then becomes a brownish pink, and then an almost clear or yellowish fluid.

At birth, your breasts contain colostrum, a precursor to breastmilk that contains vital nutrients. Your true breastmilk will come in within 24 to 48 hours after the birth. When your milk first comes in, your breasts may feel swollen and tender for a few days.

It may sting at first when you urinate after birth. It may also take a couple of days before your bowel movements become regular again. You may feel sore and bruised.

Your Newborn
At birth, your new baby already has a highly developed sense of taste and can distinguish between different flavors in your breastmilk. He can see objects about 8 to 10 inches away—which is exactly the distance between your face and his when you’re breastfeeding.

Your baby may lose a little weight right after birth. But once your milk comes in, he will begin to gain steadily. He should soak six to eight diapers daily.

At first, your baby will sleep most of the time. Gradually over the course of the next two weeks her periods of wakefulness will increase.

Touch is especially essential to newborns. Your baby needs to be held in order to feel secure and uses touch to learn about his environment. You may be surprised how much your baby wants to be held—but it is just what he needs.

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