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Oh the placenta, the forgotten organ that has kept your baby alive all this time. The organ I still have in my freezer that I have not got round to doing anything with.
I am always surprised by how many people have no idea that birth is not over until the placenta is born…. But then I guess you never see her on TV, where a very large baby appears with no cord and no placenta, so it is no wonder people are surprised when they have to birth this gorgeous bloody jellyfish once the baby has come out.
So, lets get things straight… no it’s not like birthing another baby. It is a soft, squishy, pliable organ and the baby has already ‘paved the way’ as it were. However, for a lot of people it doesn’t just plop out, it might take a bit of energy and thought. You will likely be offered active management of the placenta, where an injection of artificial oxytocin and then your midwife or HCP will pull it out via the cord using controlled cord traction. This is a while other blog for another day, with loads of benefits and risks depending on what kind of birth you have had. Today we are focusing on the things you can do to help your placenta release, and many of them would still be mega beneficial even if you are having an actively managed placenta birth. If you are taking a comprehensive antenatal or hypnobirthing course (like mine hello) then this will all be covered.
Environment
It is EXTREMELY important that once your baby is born there the (hopefully) calm, dark, quiet, warm and safe environment stays the same. We need to keep oxytocin levels high, as this is what will keep contracting your uterus, helping your placenta flop off the wall on the inside (imagine a sticker on a balloon and the balloon is deflating how the sticker would sheer off the wall of the balloon) and then the uterus will keep shrinking down to close off the blood vessels from the placental side to reduce and then stop bleeding.
One of the reasons PPH (post-partum haemorrhage) is less common in a home birth setting is because in general oxytocin levels are higher when people are in a familiar and cosy environment. But we should be setting up ANY birth space (even on a labour ward) to be oxytocin friendly, by turning the lights out and making it as cosy and familiar as possible, with great and informed birth support of course. Then this MUST continue once the baby is out.
NO turning the light on
NO facetimeing your family
NO sudden chatting or extra people in the room (unless medically necessary)
NO sudden rush to change anything in the environment at all.
We NEED to keep oxytocin high to help that placenta release and reduce bleeding. On my hypnobirthing course we talk at length about how to boost oxytocin using great support and the right environment.
Skin to skin
Another thing that is going to give you a huge BOOST of oxytocin is getting your fresh little babe skin to skin straight away. And of course we are keeping the cord intact until it is white and the baby has received all of their blood that’s a no brained and we can’t get into it now!
I see a lot of skin to skin photos with women still wearing bras or crop tops, and absolutely no shade, I certainly did this for my first birth and didn’t think much of it.
And, of course if you are really uncomfortable being totally topless then this is going to be counterproductive when we are thinking about oxytocin. But if you feel OK with it, get your partner to help you quickly whip your bra off (if you still have it on you might have flung it off ages ago in your primal birth dance) so you can get your naked baby on your naked skin, passing them all your gorgeous microbes and having that huge peak of oxytocin with nothing between you. Chat to your partner beforehand when you are doing your birth prep and discuss whether if you might want a reminder/support to take your top off!
Baby at the boob
This is also easier without anything in the way. Letting your baby snuffle and root around your boob, even if they don’t latch straight away is also going to boost oxytocin, supporting that placenta to let go and come out! Look up videos of the ‘breast crawl’ and you will see how if babies are placed on the belly they will push with their feet (massaging your uterus from the outside and helping the whole process) and shuffle their way up to the newly large and darker nipples, it’s pretty amazing.
Movement/gravity/toilet
Some people feel a pushing urge or cramping to birth the placenta, others don’t. If you are wanting to help it out a bit, gravity can really help. Get up, move about, squat down if you can, and try coughing to see if that helps. The toilet is actually a great place for placenta birth (as well as baby birth!) If your bladder is full, try having a wee as this might be blocking some space needed for the placenta to come out. Having something to eat and drink to replenish your energy will also be really helpful, particularly if you are knackered.
You have a conditioned response to relax the pelvic floor on the toilet, and most people feel pretty safe in there, so make sure you pop something in the toilet bowl to catch it if it comes out! Some people find a few drops of peppermint oil in the toilet bowl can help and doula Natalie Meddings talks about using the technique of blowing trough a straw to help birth the placenta in her book ‘How to Have a Baby.’ This is one of the (many) times where having your own doula comes in handy, as they can support you to relax/move and are likely to have some tricks up their sleeve!
We don’t need to be doing any of these things in a stressy or panicky way. Yes, the placenta does need to come out, and you will be coming under pressure from your HPC’s if it’s not out within the hour, but keeping calm and sniffing your gorgeous new baby will really help. And don't forget, your placenta is YOURS! So if you want to keep it, make sure you have told your midwife and your partner knows just in case it get chucked before you get a chance!
Understanding birth hormones and how to support birth physiology is massively helpful for the entire birth process. Come along to my fabulous Hypnobirthing antenatal course to learn how totally epic your body is and how you and your birth team can support you, regardless of where or how you birth.
Lastly, shout out to the placenta. What a babe.
Lastly, lastly... If you want an excellent evidence based deep dive into all things placenta, check out Dr. Sara Wickham's incredible book, "Birthing Your Placenta" It is fab and tell you everything you want to know!
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