In this series on labor and delivery off the grid, we’ve emphasized the importance that knowledge of the birth process plays in producing a healthy newborn. In parts 1 and 2, we got you all the way through the delivery of the baby. With the baby in the arms of its mother, you might think you’re done, but you’re not. You still have to deliver the placenta, otherwise known as the “afterbirth.” This is the third stage of labor. You’ll also have to look for and repair vaginal tears incurred during the delivery.
THE BABY’S OUT: NOW WHAT?
Suctioning nose and mouth with a bulb syringe
Once delivered, the baby’s nose and mouth are suctioned out again to remove amniotic fluid and clear breathing passages. Then, place the newborn on the mother’s chest. It will usually begin crying, which is a good sign that it is a vigorous infant. Spanking the baby’s bottom to get it to cry is rarely needed, and is more of a cliché than anything else. A better way to stimulate a baby to cry is to rub the baby’s back while drying it with a towel.
Once dry, wrap the newborn up in a towel or blanket. The head (but not the face) should be covered to avoid heat loss. At this point, you may clamp the cord twice (2 inches apart) with Kelly or Umbilical clamps, and cut in between with scissors. There is usually no special hurry to perform this procedure. The items needed are available in commercially produced delivery kits.
THE THIRD STAGE
Once the baby has delivered, it’s the placenta’s turn. Be patient: In most cases, the placenta will deliver by itself in a few minutes. Avoid pulling on the umbilical cord to force the placenta out. Breaking the cord due to excessive traction might require your placing your hand deep in the uterus to extract it. This is traumatic and can introduce infection. You can ask the mother to give a push when it’s clear the placenta is almost out. The process may take up to 30 minutes.
If too much time has passed, traction may possibly be necessary. Place your fingers above the pubic bone and press down as you apply mild traction. This will prevent the uterus being turned inside out (yes, this can happen) and life-threatening hemorrhage may occur. A moderate amount of bleeding is not unusual after delivery of the afterbirth.
The fetal surface of a placenta
After the placenta is delivered, the uterus naturally contracts to control bleeding. The top, or “fundus,” is now felt around the level of the belly button. In long labor, the uterus may be as tired as the mother after delivery and may be slow to contract. As a result, this may cause excessive bleeding. Although drugs like oxytocin are given in modern times to firm up the uterus, massaging the fundus should also work to limit blood loss. Uterine massage may be necessary from time to time during the first 24 hours or so after delivery.
Once bleeding is under control, examine the afterbirth. The “fetal” surface is grey and shiny; turn it inside out and you will see the “maternal” surface, which look like a rough version of liver. The fetal surface is separated into sections called “cotyledons”.
If one of the cotyledons remains inside, there will appear to be a section missing and bleeding may be difficult to control. This may have to be extracted manually. Using a gloved hand, detach the placenta from the wall with your fingers and gently pull it out. Expect the mother to experience some pain. Antibiotics are helpful to prevent infection.
RECOVERY
Recovery is often called the fourth stage of labor. It is during this time that the mother’s body begins the process of returning to its pre-pregnancy state.
Treatment rendered during the time period after the three stages of labor are completed is called “postpartum care.” Evaluate the vagina for signs of tears, which can be repaired with absorbable suture. You’ll be monitoring for bleeding and infection over the next few days. In normal situations, the bleeding will become more and more watery as time progresses. Have a supply of sanitary pads in your medical storage. Also, keep an eye out for evidence of fever, foul discharge, or other signs of infection (usually bacterial).
Do pelvic floor muscle training, also called Kegels, to tone pelvic floor muscles and help control bladder leakage. To do Kegels, tighten your pelvic muscles. Try it for three seconds at a time, then relax for a count of three. Work up to doing the exercise 10 to 15 times in a row, at least three times a day.
It would be wise to place the baby on the mother’s breast soon after delivery. This will begin the secretion of “colostrum,” a clear yellow liquid rich in substances that will increase the baby’s resistance to infection. Suckling also causes the uterus to contract, which decreases blood loss. It’s also important to recognize the bonding element between mother and baby when breastfeeding.
It should be noted that there are different schools of thought regarding some of the above, many of which are equally valid. Remember that your goal is to end up with a healthy mother and baby, both physically and emotionally. in the last part of this series, we discuss the delivery of multiples (twins and above) and of unusual presentations, like a breech birth.
via doomandbloom
