The 3rd Stage of Labor: The Afterbirth!

One would think that making the difficult decisions is done after the birth of the baby, but there is still so much to consider!

The placenta is a disposable organ that forms during the pregnancy. This important organ, connecting mom and baby, provides the baby with the nutrients it needs to develop and prosper. It also gets rid of the baby's' wastes. Protective immunity passes from mom to baby through the placenta, but diseases can too.

After the birth of the baby, the placenta will need to be delivered. In the majority of cases, an infusion or intramuscular injection of oxytocin (pitocin) will be initiated after the birth of the baby. This will promote the separation of the placenta from the uterine wall and keep maternal bleeding to a minimum. This process is called active management and is common practice in many locations across the country.

Separating the baby from the placenta is another topic worth consideration. It is common practice among obstetricians to immediately clamp and cut the umbilical cord upon birth of the baby, a practice less common with midwives. Some families decide to wait for the umbilical cord to stop pulsating before it is cut. Conflicting opinions as to whether delayed cord clamping is beneficial exists. Some studies show that delayed cord clamping may cause babies to have polycythemia, or elevated red blood cells, resulting in jaundice. More studies indicate that delaying cord clamping by about 2 minutes can help to prevent anemia and bleeding in the brain for term newborns. There is no definitive right or wrong choice here so discuss this with your practitioner and decide on a mutually agreeable and appropriate plan of action for your delivery. * Keep in mind that if the umbilical cord is wrapped around the baby's neck at delivery, it may need to be cut immediately for the safety of the child. Also, if baby is born and does not cry and respond to the stimulation attempts made by the healthcare team, it may not be plausible to delay cord clamping for 2 minutes while the baby is not breathing. Even fewer families opt for a Lotus birth. With a Lotus birth, no intervention is taken to separate the baby from the placenta. Instead, the two remain attached until nature takes its course and the placenta and umbilical cord rot and separate from the baby.

Once the placenta is delivered, what do you plan on doing with it? If you have no particular plans for the placenta it will typically be incinerated by the hospital. But, there are numerous options regarding the disposition of the placenta as well. Women in some cultures bury their placenta's. In other cultures it is common practice to consume the placenta. Yet other cultures believe that the placenta has medicinal properties and use it in creams, powders and teas. Many birthing centers will allow families to take the placenta home if requested. What you do with your placenta once home... that is totally up to you. Placenta art is another thing that has been catching on.

In some circumstances the doctor may request that the placenta be examined in detail and be sent to pathology. This may happen if mom develop's a fever during labor and a uterine infection is suspected. The placenta may also need to be studied if the baby has any birth defects. If this is the case it may not be possible to obtain the placenta and take it home.

Cord Blood Banking/ Donating

Yet another amazing option with the placenta is to bank the cord blood. Umbilical cord blood contains stem cells, as in the more familiar bone marrow, that can be used to treat leukemia, sickle cell disease among other ailments. Studies are continuously being performed to find other uses for cord blood stem cells. In some states there are free, public cord blood donation programs. Private donation is also an option. Most pregnant women have received literature from any or many of the popular cord blood collection and storage agencies. the difference between cord blood donation or private cord blood banking include the following:

• When donating cord blood it is free of charge. Cord blood banking can be expensive, with a one time initiation fee anywhere from $500-$2,500 followed by an annual fee as long as you continue to bank the cord blood.
• Donated cord blood goes into a public bank like bone marrow and is distributed on a first come first serve basis. Privately banking cord blood reserves it for use at your discretion.

Cord blood banking or collection does not interfere with your ability to take the placenta home. The stem cells are found in the cord blood remaining in the placenta and umbilical cord after the placenta is separate from the baby. Immediate cord clamping and cutting will result in you having a larger banked sample, but it is sometimes possible to delay cord clamping and get enough of a sample. It is not possible to collect or donate cord blood if a Lotus birth is planned. Either way, once the blood is collected, the placenta can be returned to you if you would like.

Who would have guessed that the topic of the placenta alone could require so much consideration and decision making. Hopefully some of your questions have been answered, or your eyes have been opened to ideas or possibilities that you had not known existed. Best wishes!