The birth of the placenta isn’t talked about much when women share birth stories.  In fact, even in the most unhindered births, the birth of the placenta is often still managed by the midwife and mothers don’t expect they will have much of a role in this part.  Even knowing the delicate nature of this time, too much is usually happening in this moment to support physiological placenta birth, causing postpartum hemorrhage rates to increase.  While most women manage the expected blood loss at birth well, preventing hemorrhage should still be top priority for the mother, father, midwife, and everyone attending a birth.  The time from the birth of the baby to the birth of the placenta is especially delicate as the hormones needed are incredibly sensitive to the environment and need to remain balanced for bonding and maternal-fetal safety.

After birth, contractions may stop for a few moments, but as baby begins to breathe well, they’ll nuzzle mom and can crawl up her belly to latch, creating hormonal balance and a firm uterus.  Note how important it is for baby to be breathing well, indicated by a baby initiating breastfeeding. These after birth contractions can be strong, usually increasing in strength with each birth, to help squeeze the placenta for detachment and clamp the uterine capillaries that attach to the placenta so that blood flow is significantly reduced. This action of safety is directly related to the mother’s nourishment, how calm the mother feels after birth, if baby is skin to skin, and if mom can focus only on bonding with her baby.

It is important that no one starts unnecessary chatter or rushes to call family members.  It is important for dads, and anyone else attending the birth, to stay quiet and calm, and the room very warm and dimly lit.  This environment helps mom and baby teach each other, moments that will never again repeat and are imperative to birth safety.  Warmth helps moms feel cozy and safe, decreasing adrenaline and increasing oxytocin, the exact action she needs.  Too much happening around mom (people chatty, people pushing on mom's uterus, people pulling on the cord) all have the potential of causing hemorrhage and ultimately interfere with the initiation of breastfeeding.  If mom had a spontaneous (no induction of any kind, not even herbs) unmedicated, physiological birth, and she appears alert and joyful and there are no visible signs of active bleeding, be assured she is doing well and her body is doing just as it was created to do… just as in labor and birth.

For a well-nourished mother with adequate blood health, it is not only normal to lose a cup of blood, but may even be beneficial. For a mother that is not well-nourished or that has experienced a hindered or medicated labor, this time does have increased risks. Regardless, although Pitocin may reduce blood loss immediately after birth, it can cause secondary hemorrhage hours or days later (well after the midwife goes home) and increases chances for retained membranes which can further increase secondary blood loss, infection, and reduce milk supply.

The uterus should stay very firm after birth as it clamps down around the placenta. When the placenta is ready to birth, contractions increase and there is often a gush of blood that is seen as the placenta releases.  The bleeding should stop and not continue.  Having an empty bladder will help this time, just as it does during labor, and you may even need to get up to empty your bladder to support the birth of the placenta if you had a difficult time emptying your bladder in labor.  With a physiological labor and birth nothing extra needs to, or should, happen within this first hour.  However, after 30 to 60 minutes, sometimes a change in position, a cough, and a gentle check of the cord to notice placenta separation may be helpful.  Watching mom's alertness is the key here.  It is important to note, this gentle approach will not happen in a medical environment as they are not taught this.  In fact, even most home birth midwives don't approach the placenta birth in this way.  If you want this approach to your placenta birth, you're going to have to seek it out and ask your midwife or OB what this time typically looks like for their clients.

Once the placenta is born, the placenta is examined to ensure there are no chunks missing or membranes that appear to be retained inside the uterus. Additionally, the color and appearance of the placenta is like a journal of the pregnancy; just like other organs, its condition can tell a lot about the mother’s diet and overall health.

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