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Old 02-25-2005, 05:16 PM - Thread Starter
 
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I've had a string of beautiful births lately, with moms & dads catching their babies while my assistant and I sit back, our hands never really getting wet at all (most of my clients birth in the water).

After the births, my assistant and I are really quiet and we move out of the way towards a place where we aren't "right there" after the birth happens.

We watch women, and I see that "grimace" and uncomfortable look on the mom's faces as I believe the placenta separates.

For those of you that birthed in the water, did you birth your placenta in the water?

Were you aware that it was time for the placenta to come out? How?

Did you use any cord traction at all while birthing the placenta?


For the past two births in water, even the last two on land, the placentas separate, but even 15 minutes later, there is no placenta born. It isn't until some slight cord traction is applied before the placenta is born into the vagina and then out.

Input?
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Old 02-25-2005, 05:30 PM - Thread Starter
 
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Just wanted to add that a wise midwife answered my questions on an email list. Her response really fit in with what I've been feeling in my heart, but the brain/book side of me couldn't get over....

separation and expulsion are two different processes.
The placenta "may" separate from the uterus after only five or ten minutes.
From there it spontaneously moves through a series of small contractions to
the upper vagina. There's generally no harm allowing the placenta to descend
through the natural process. The uterus is strongly contracted and there
isn't any additional bleeding (the placenta is in the vagina, or lower
uterus; its' harmless there; it isn't holding blood vessles open)


When the placenta descends enough to put pressure on the rectum, the moms will often feel uncomfortable and let you know that "something's happening". Sometimes they will just spontaneously push. Or you can see the cord has come "way down" -- or can see the membranes, or bulge.

Here's a common time table:
We will often see possible signs of detatchement within about ten minutes of
birth.

But... if we allow a "mother led" third stage, the placenta sexpulsion stage
seems to happen at just about 20 to 30 minutes after birth.

We can make it happen faster sometimes, by changing moms position. And we
can certainly often make it happen quickly by just pull the thing out at any
time.

But I don't like to intervene unless there's a good reason.

Twenty minutes -- a half hour -- goes by very fast if moms are busy loving
their babies. The placenta's often ready to come, just about the time many
moms are ready to get a change of clothes -- or want to get out of the tub.

There are NO absolute rules -- and NO routines which apply to all women. But
-- in general -- with waterbirths, we generally expect to get mom out of the
water when it's getting close to half an hour after birth (things have
settled down, and the water is often cooling). "As a general rule", moms
first move to a chair beside the tub. We have the placenta chux ready,
because shortly after mom stands up to get into the chair, she often feels
the placenta sliding down.

When waterbirth first became popularised, there was a thought that the
placenta shouldn't be delivered in the water. We were supposed to rush them
out before the placenta came. But because i've always done "mother led third
stage" it didn't seem to be an issue though. The moms almost always were
ready to leave the water before the placentas came. And our clocks almost
always showed this was about a half hour after birth (give or take ten
minutes).

If you read the older midwifery texts -- and the older OB texts -- they all
say to expect the placenta comes at about 20 minutes to half an hour --
"sometimes longer".

They didn't have the newer understanding that placenta's may often separate
more quickly than this.
But they did have the age-old observation that it usualy took about a half
hour before the placenta "appeared".

I'm still comfortable viewing the third stage as a two-part process of:
1. separation and
2.expulsion.

And so far, I'm still willing to let the process occur in it's natural time
-- while being ready to intervene at any point if needed.

It's an individual decision though ---- one we all need to work out with
our clients.




You know, up until the last couple years, I had so unlearn all the anxiety that I learned in my training at the time of birth. I've become so much more relaxed about birth in general - but it's amazing that I'm still struggling to UNlearn all that was taught to me as "dangerous".

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Old 02-25-2005, 05:50 PM
 
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my last was a water birth. i didn't birth the placenta in the water.. simply cause i knew someone would be syphon(sp??)ing the pool at some point and i have a history of pph (due to caregiver issues who pulled the cord before speperation) so i wanted to be out of the water so i could determine my amount of blood loss, which was fine...also my babe wasn't all that into being i the water for some reason.. she settled down a lot after i stood up and stepped out..it was smooth though.. I forget what exaclty told me it was time to get out.. a contraction that was a bit more crampy.. slight pressure, cord loosens...or just some inner voice..sorry not more help.
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Old 02-25-2005, 06:18 PM
 
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I had my unassisted birth in water. I did not do anything about getting the placenta out. I just stood up to get out of the tub, stepped over the side, and my placenta just fell out. As I was sitting in the water, there was blood starting to go into the tub so I was concerned, but I now realize that was probably my placenta separating from the wall of the uterus. I think if I had stayed in the tub, my placenta would have been "born" there. It was about 10-15 min after the baby came out, too.
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Old 02-25-2005, 07:44 PM
 
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For those of you that birthed in the water, did you birth your placenta in the water?
I have only had one birth so far, a midwife attended homebirth. The m/w wanted me out of the pool at 15 minutes and had me pushing to get my placenta out.

Were you aware that it was time for the placenta to come out? How?
No. Actually I was aware that it was NOT time for the placenta to come out yet. I do not know why, but I seriously feel that the placenta was still attached at 15 minutes and even though there was no visible pulsing of the cord, I feel that there was oxygenated blood still going to my baby.

Did you use any cord traction at all while birthing the placenta
No. Just concentrated maternal effort, I wanted a lotus birth and definitely did NOT want that syntrometrine injection from my m/w if the placenta did not come out in 30 minutes

The placenta did detach (I felt this detachment more so because I was pushing to try and get it out) after about 5 minutes of effort, and I felt it fall from high up in my uterus somewhere, to land on my cervix and then it plopped right out with a smaller push from me at the same time it hit my cervix.
With the placenta, came the seperation gush.

Its definitely an UC next time - I did not like how things were handled after my child was born.

Btw, my body went in some kind of shock of flip out mode after the placenta was born. It was like "hey! wait! not ready!" and I immediately felt awful/wrong and lost a lot of birth energy... which led to more concerns from m/w because I laid down and did not want to move for hours.
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Old 02-25-2005, 08:55 PM
 
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My last birth was not a waterbirth but I felt I could still answer

I never felt the seperation but I knew after a certain time frame that the placenta was no longer attached. At that time we cut the cord (DD had a short cord so we were getting a bit uncomfy having to be hunched over). I nursed her for a bit and got her to sleep, and still no feeling of the placenta to come. I decided to get up and head to the shower and get cleaned up while waiting.

I could feel the placenta sitting in my uterus and felt safe to give a bit of cord traction. Once I did the placenta easily slid out.

Now I am sure with my 2 previous hospital births my placenta was pulled out before it was ready and its possbly why I never got the signals to push the placenta out with my UC. In any event I know a midwife or OB would have definetly done some manipulating to get my placenta delivered sooner. In fact I am sure that my current midwives would attempt something should my placenta not birth in their timeframe...yet another reason why I do not want them here invading my space.
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Old 02-26-2005, 12:57 AM
 
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For those of you that birthed in the water, did you birth your placenta in the water? i got out of the water both times just before birth so no

Were you aware that it was time for the placenta to come out? How?
yes, pressure on my rectum and a little feeling of needing to get this outa me-- went and sat on the toilet-- I guess i was thinking of the mess- also cut the cord just before going into the bathroom because I wanted to focus on me a bit. like hold the baby while I do this

Did you use any cord traction at all while birthing the placenta?
NO

-----------------
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Old 02-26-2005, 01:18 AM
 
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I've had two UC's -- one land, one water.

W/both, I was ready for the placenta to come out before IT was ready. :LOL So I pushed several times and nothing happened, then finally just felt an urge to push (similar to urge to move bowels) and otu it came.

With the land birth, I was kneeling on a chux holding baby. I jsut birthed it onto the chux, and we picked it up and put it in a bowl.

My waterbirth was a REALLY interesting (to me) placental experience. I wanted to stay in the water til it came, but after a while (how long? who knows?) baby was cold and starting to fuss. What had happened, was that the placenta had descended, and birthed mostly out of my vagina, but when I reached down to pull it away I felt a pulling inside. This lasted several minutes. I didn't want to yank it bc it was 1)uncomfortable to pull and 2) I knew better. So I waited and waited -- reached in to feel how far up the piece went, and couldn't feel where it ended -- and finally, I handed baby to dh, held my placenta against my vagina, and climbed out of the aquadoula. When I lifted my leg over, like a PP -- there was a big clotty splash (yaya! we put down plastic!) and the placenta was released completely. Again, plopped it in a bowl and I jumped in the shower, then we all climbed into bed til the bigger kids woke up.

The placenta really does come by itself. I sort of understand your perspective-- when I called the midwives office after my first UC (lots of tearing I wanted checked out) they were like, "Who delivered the baby?" "I did." "No, I mean, who attended the birth?" "I did." "no, no, I mean, who helped you??? Who was there?" "My husband and my 2yo were there; my husband helped me take off my underwear, catch, and clean up." "But, but, well, then, who delivered the *placenta?* (sounding desparate) At this point I just started to laugh. "The placenta came out all by itself!" (At this point, the receptionist ... "I think I should get somebody else to talk to you." :LOL )
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Old 02-26-2005, 01:38 AM
 
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"Btw, my body went in some kind of shock of flip out mode after the placenta was born. It was like "hey! wait! not ready!" and I immediately felt awful/wrong and lost a lot of birth energy... which led to more concerns from m/w because I laid down and did not want to move for hours."

Yeah, that's how it felt to me too, with my midwife-led expulsion efforts. (It had been 15 minutes, "too long", and I was so tired... ugh.)

Pam, gooood questions. My one waterbirth was also the one where the placenta took over an hour to come out (not in the water, I'd been asked to get out so they could get a better idea of blood loss) -- I'm sure it had detached long before that, I have no idea when though because I was really not focused on what my body was doing -- I was focused on the other people in the room, and what the midwife wanted me to do.

I don't remember much of my 1st UC third stage, because again I was unfortunately distracted. But this last time, I remember very well what happened. I sat for about 15 minutes with the baby, totally blissed out, and I then started getting a bit uncomfortable and knew that moving would relieve that. It was exactly like how it is when you're laying in bed in one position too long and you get that clear message from your body that you need to turn over or bend your legs or whatever. There was also a distinct shift in my consciousness. I'm certain that's when the placenta separated. I got up then and walked to the other end of the house and sat in the recliner with the baby and nursed a bit. About 15 minutes later, again, it felt like I needed to do something, a kind of restlessness. I just felt done with that phase of it. I cut the cord, handed the baby to my husband, and squatted over a bowl while doing a little nipple and breast stimulation. I felt for the tension on the cord, not sure why I did that as I wouldn't actually pull on the cord. Then I bore down a bit, experimentally, and shortly thereafter felt that indescribable feeling of fullness and release as the placenta plopped out.
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Old 02-26-2005, 03:59 AM
 
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For those of you that birthed in the water, did you birth your placenta in the water? No

Were you aware that it was time for the placenta to come out? How? Yes, it was very much instinctual, intuition. Just a feeling that it was time to change.

Did you use any cord traction at all while birthing the placenta? No. I had been sitting in the pool with my baby for about 20 min, maybe 30. I felt it was time to get up, I stood and asked DH to take the baby. He held her in one arm and offered his other to me for stability, I got out, there were towels on the floor. He handed me the big bowl we'd set aside, I squatted over it and gave a push. The placenta plopped right out into it, along with a gush of blood. Then I put another, clean, towel between my legs and walked to my bed in the other room.

That was my most recent birth, and the cord was very long and skinny. The previous birth, the cord was very short and thick, and I couldn't hold him comfortably.. I sat sort of cross legged with him in my lap and leaned my breast down to him. It couldn't have been 10 minutes before I felt much cramping and a need to push, so I lay him on the bed next to my knees, got up onto my knees and pushed the placenta into the same bowl. There was a much smaller gush of blood with this one, we were just in awe at how little blood there was for the entire birth-- it was scant. His cord continued to pulse for at least 15 minutes AFTER the placenta delivered, I swear. He had been born with a nuchal hand, btw. 10 lbs, or heavier... we didn't weigh him for about 30 hours, and at that time he was 9 lbs 15.5 oz. His head was 39cm. Funny thing is that I had a moment of deja vu as he was being born. His head had crowned, and I felt like he was sitting there. I had a vision, if you will, of a baby with his fist at his cheek. I reached down, felt baby's head and reached to his cheek, where I did in fact find his fist. I looped my finger around his wrist and gently tugged, and he just came flying out with his fist leading, like Superman! Dh barely caught him, he came out so fast. He was squalling as soon as his head was completely out, before his body came out. I'll have to get that video online. It was cool.
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Old 02-26-2005, 05:32 AM
 
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Quote:
Originally Posted by tryinghardmomma
I had a vision, if you will, of a baby with his fist at his cheek. I reached down, felt baby's head and reached to his cheek, where I did in fact find his fist. I looped my finger around his wrist and gently tugged, and he just came flying out with his fist leading, like Superman! Dh barely caught him, he came out so fast. He was squalling as soon as his head was completely out, before his body came out. I'll have to get that video online. It was cool.
Yep had visions with my first homebirth- I could see-feel is how i put it when the baby dropped and spun to come out - some other visions as well but...very OT but wanted to say something.
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Old 02-26-2005, 02:05 PM
 
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How interesting -- I too had a vision when the baby's head was out, of her turning so the rest of her body could be born. It wasn't like an imagining or a dream, it was more like... gee, I don't know, so hard to describe. Like a third eye kind of thing. I "saw" but not as if with my eyes.
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Old 02-26-2005, 04:41 PM
 
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I birthed the head in water but the body on land on all fours. I sat/reclined down on a mattress on the floor with the baby for a while. Baby was freaking out crying from some asphyxiation coming out so I tried sitting in the hot tub with him. He didn't calm down so I went back to sit on the mattress. DH and DD were home at this point and I asked DD to nurse because the baby wouldn't (tongue tie or freak out, take a pick). She did but not much with a squalling infant distracting her. At some point I had a very mild cramping sensation that I figured was a contraction. At some point I decided I wanted to go into the bathroom to birth the placenta and turn on the overhead heater and have a nice hot bathroom. Baby and I went there and I had one or two cramps there and at some point just leaned over standing (slightly bent knees) to release the placenta which fell to the floor. 3rd stage was 15 or 20 minutes (estimated). I did not notice separation.
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Old 02-27-2005, 08:04 PM
 
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During my accidental UC, my baby was born on land (half sitting/squatting on the edge of my hideabed.) We had called 911 (wouldn't do that again, for sure) They eventually showed up, and cut the cord while I was trying to get dd to nurse. Her cord was on the short side, so it was hard to reach her to the breast. I got up and walked out the the ambulance, and am sure the placenta separated then. I had a lot of cramping and an urge to push again when we arrived at the ER. Must have been about 30 minutes by that time. Then chaos ensued in the ER. I said I wanted to push the placenta out, and various people compained that there wasn't a bucket handy, and then much worrying that I was somehow now going to bleed to death. Then the idiot on call OB resident insisted that I have an IV before delivering the placenta. I was really uncomfortable by then, and tried insisting that they let me up to deliver the placenta. After a while, I got tired of arguing and let them stick me for an IV, during which the nurse forgot to have her tubing ready and I bled from the IV site all over the floor for a while. Eventually, then the silly OB made me scoot down into stirrups, and with one push before she could get organized, the placenta plopped out. I think it must have been close to an hour from birth of the baby.
I don't remember the 3rd stage from my first birth at all. I only remember feeling higher than a kite holding my baby!
My 3rd and 4th births were attended, and both in hospital. Both times the doc was very hands off about the placenta. It took close to half an hour both times before I felt some more cramping, a gush of blood, and wanted to push the placenta out on my own.
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Old 02-28-2005, 10:16 PM
 
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My last birth was an unexpected UC (waterbirth). Once she was born I just wanted to get out of the water and nurse her so the placenta would come out. I had the "lets get it over with already" feeling. The midwife arrived about ten minutes after the birth - I was already lying in bed then & just about to nurse. We requested she draw the cord blood. After that she asked me if I felt like the placenta was right there. I didn't have a clue. I gave a little push and out it came. I figure that was probably about 15-20 minutes after the birth.

Mama to four remarkable kiddos, all born at home.
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Old 03-01-2005, 11:47 AM
 
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Our UC was not a water birth, I wanted to answer though. I knew that the placenta had seperated, I felt a small gush of blood and I felt the cord lengthen. I didn't feel any contractions, I squatted over a bowl and gave a small push and out it came. I was a little upset that dh cut the cord too early, but he was nervous so I forgive him, it made birthing the placenta easier for me in the long run.

Kasey
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Old 03-09-2005, 02:50 PM
 
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I just wanted to say what an interesting thread this is. I never gave this part of labor much thought. I know that unassisted childbirth isn't for me, but I might be interested in something like Pam described - the midwife and assistant just sit around and wait in case they are needed and they don't automatically jump in. Thanks for giving me more to think about!
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Old 03-09-2005, 04:29 PM
 
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Quote:
Originally Posted by blueviolet
How interesting -- I too had a vision when the baby's head was out, of her turning so the rest of her body could be born. It wasn't like an imagining or a dream, it was more like... gee, I don't know, so hard to describe. Like a third eye kind of thing. I "saw" but not as if with my eyes.
not to derail the thread, but wow...I, too, had a vision during my ds's homebirth, as he was crowning. My "third eye" "saw" the dusky pinkness of his head emerging. I never knew of another woman to experience this--it was more than "an idea" or an imagining at the time.

To address your post, Pam, here's my experience (this info is not from my birth brain memroies, rather, watching my birth video, so the stats are very accurate.)

I had a minimally-interventive homebirth and baby was born at 6:18. mws checked and felt a pulse in the cord, and did nothing.

At 6:26, I was complaining about something not feeling right in my crotch region (I was so overwhelmed with general crotch unpleasantness at the time, I can tell you I was not pinpointing a feeling of 'fullness'!) my mw looked at my bottom and suggested I give a little push. There was no pulse in the cord at this time.

As it happened, the placenta was hangin' out in my vagina--which was one of the crotch-unpleasantness culprits--and my mw did "pull" or help ease the placenta into a bowl, as I easily, gently pushed once or twice.
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