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Physiological separation of the placenta

Abstract:

Physiological separation of the placenta is something that most doctors and midwives have never seen. The mere thought of it fills them with fear and anxiety. Frequently the birth attendant in hospital is in far too much of a hurry to wait for the placenta to separate on its own, or is fearful of what will happen if an ecbolic is not given. Clearly most women do not need a 'routine' ecbolic. There are potential dangers in receiving syntometrine when it is not needed, for example, in the case of undiagnosed twins, or the rise in blood pressure that is sometimes caused by the ergometrine in syntometrine. Surely it makes more sense to assess the needs of individual women. An ecbolic (IV oxytocin or IM syntometrine) can be given with good effect, if needed, either before or after the placenta has been expelled. In my experience when no ecbolic is given, the placenta usually appears within 20-30 minutes of the baby being born, although often it is much sooner than that. Usually the woman feels some backache or a contraction and may have a small amount of bleeding and pushes the placenta out. Often the placenta is expelled before the cord is cut, while the mother is holding the baby. This was part of a paper 'Study of 100 planned home births' presented at the 1990 Midwives Conference. (This is the full version of what was published in the Journal.)

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ecbolic, placenta, third stage of labour