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Third stage of labour


During the third stage the placenta is delivered. The cord is cut straight after the birth of the baby and an intramuscular injection of a drug called syntometrine is given to the mother. Syntometrine is an artificial form of the hormone oxytocin and speeds up the separation of the placenta from the lining of the uterus. It is administered in the mother’s thigh once the baby’s shoulders have been born. The doctor will gently pull on the cord to assist the placenta out once there are signs that it is separated from the uterus. The entire process takes 5-8 minutes on an average.

Sometimes the placenta does not come away quickly, or only part of it comes away, and it has to be removed manually. You may be moved to the theatre for this and you may be given an epidural or spinal before it is done.

In most hospital units, the third stage is ‘actively managed’, which may speed up this stage of labour. However, you may choose a physiological, ‘unaided’ third stage.

You may have an injection to cause the uterus to contract or shrink. This is given when the baby is being born, usually when the first shoulder is coming out. The injection will go into your thigh or buttock.
•Once your baby is born, the umbilical cord is clamped and cut.
•As the injection takes effect, it stimulates the uterus into contracting, causing the placenta to detach. At this stage, you may be able to push the placenta out. More usually, the docotr will help deliver it by putting a hand on your tummy to protect the uterus and keeping the cord taut (this is called ‘cord traction’).
•The placenta comes away and the blood vessels that were ‘holding on’ to it close off as the muscle in your uterus contracts. This prevents bleeding – although it’s normal to bleed a little. You may feel the placenta slide down and out between your legs, followed by the membranes.

 
Sometimes complications can occur:

 •Occasionally, the placenta does not detach from the uterus. When this happens, the mother needs a small operation (under anaesthetic) to remove it.
•Sometimes women will bleed severely during the third stage. This is called postpartum haemorrhage or PPH and needs to be treated immediately.


After the birth

Skin-to-skin really helps bonding, so it is a good idea to have your baby lifted onto you before the cord is cut so you can feel and be close to each other straight away. The cord is clamped and cut, the baby is dried to prevent him or her from becoming cold. Your baby may be born covered with a white, greasy substance known as the vernix and some of your blood. Sometimes mucus has to be cleared out of a baby’s nose and mouth. Some babies need additional help to establish breathing and may be given oxygen. Your baby will not be kept away from you any longer than necessary. Your baby will be examined and weighed, and given a band with your name on it.

 
 

 

You may hardly be aware of the third stage, as you will be focused on your baby. You may feel shaky due to adrenaline and the adjustments your body immediately starts to make, or you may simply be on a high. You may find it hard to pay attention to the baby if you have had a long labour. There’s nothing wrong with your maternal instincts; you are simply exhausted. If this happens to you, take your time. After a rest you will be much more interested in getting to know your baby. A lot of women are very hungry and ready for tea and toast, while others want to telephone everyone and tell them the wonderful news!
 
Admire your new baby. Count her fingers and toes. Hold her close to your body, preferably skin to skin. Rest together in skin to skin contact. Baby may start to show signs that she wants to feed and you can then offer your breast. If you’re going to breastfeed, offer your breast as soon as possible; your nurse will help you. Don’t worry if your baby doesn’t seem very interested. Even if she’s only touching and nuzzling you, this will help her to get going with breastfeeding.
 




Episiotomy

Episiotomy is a surgical cut made between the vagina opening and the anus to make the vaginal opening wider. Your doctor will do this if she thinks you will tear badly, or if the baby needs to be born quickly. The area is usually numbed first, or it can be done at the height of a contraction when it doesn’t hurt.

It may be used if:

 

 

 

  • You are very tired and your baby seems to be distressed

  • A forceps or ventouse delivery is needed

  • There is a problem delivering the baby’s shoulders

  • You have had previous surgery involving your pelvic floor muscles
 
 

 


You can try to avoid episiotomy by:

 

 

 

  • Using different positions during labour

  • Using an upright position for giving birth

  • Listening to your body and pushing when you want to

  • Listening to your doctor when she tells you to stop pushing and pant as the baby’s head is being born

  • Massaging the perineum in late pregnancy is proven to reduce the need for episiotomy during labour. You can use non perfumed oil such as olive oil.
 
 

 



Coping with stitches and bruising


If you have had a cut (an episiotomy) or a tear during the birth, your perineum will be swollen and bruised for a while. The most important thing is to keep the area clean; change your pad regularly.

Other things that will help:

 

 

 

  • Use a bidet ( if possible)
     
  • Dry the area carefully

  • When passing motion, try not to strain. If you are constipated, ask your doctor to give you a laxative such as lactulose.

  • Use cold compresses like gel pads.

  • While on the loo, pour a jug of cooled, boiled water over your stitches

  • One or two days after the birth of your baby, start your pelvic floor muscle exercises every day to increase the flow of blood to your stitches and speed up healing

  • Rest and sleep on your side as much as possible. Your doctor will show you how to feed lying on your side

  • Sit on a soft pillow

  • Eat a diet rich in fibre as that passing motion is easy.

  • If you are worried about opening your bowels for the first time, fold a clean sanitary pad in half and hold this on your stitches while you go.

 
 
 

 


Special deliveries

Between 5 and 20 % of all births require the help of forceps or the ventouse cap. This type of delivery is known as assisted vaginal delivery.  Some babies need a little help to be born. Forceps or ventouse may be used during the second stage of labour if:

 

 

 

  • The baby has an abnormal heart rate recording, suggesting lack of oxygen (foetal distress)

  • The baby’s head is in an unusual position in the pelvis

  • If mother is exhausted and has no more energy to push

 
 

 

Forceps are curved metal “tongs” that are used to hold the baby’s head while ventouse is a vacuum cap that attaches to the baby’s head. A cut may be made to your perineum i.e. episiotomy, which makes more room for the baby to come out. The forceps or ventouse are fitted, then with each contraction, while you push the baby out, the doctor will pull gently and steadily to help the baby progress. Your baby may have marks from the assisted delivery but these fade over the first few days. You may have stitches and bruising after an assisted delivery. Therefore, it is important to keep the area around the stitches clean.

If the use of forceps or ventouse is not successful, it may be necessary to perform an emergency Caesarean section.

 

 

 

 

 



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