Fourth Stage of Labor and Midwifery
by Jan Tritten

[Editor’s note: This article first appeared in Midwifery Today, Issue 102, Summer 2012.]

cover of Midwifery Today Issue 77 with Jan and friendThe fourth stage of labor is defined as the first hour or two after birth. I think we should redefine it as birth to twenty-one years of age, or maybe for the lifetime of the child. The issues never end once you are a parent. But let’s go back to the first hour or two after birth because this editorial doesn’t have enough space for 21 years! The first hour after birth is so very important. I asked on my Facebook page, “What are the most important considerations for this time?” Zuki Abbott-Zamora, a birth consultant, summarized it with this comment, “Quiet distant observation. Help with anything if needed, but keep your voice very low and humble; give space if you can. Sometimes you need to help the mom help herself or her baby, but do not disturb the moments of connecting!”

My response to Zuki’s beautiful insight was, “Okay, now if we can get every single birth practitioner in the world to do this, we can change this mean old world!”

I do truly believe that being with mother, baby and family is a sacred trust bestowed on us. Just think what would happen in society if this were the approach to every single birth. As Mabel Dzata, an amazing midwife friend, says, respect is so important and so missing in birth in general.

We practitioners need to watch ourselves that we don’t disturb motherbaby. This is their time—the most important time in each of their lives and the time their oxytocin is the highest. God has a purpose for this: the motherbaby bond—our highest calling is to serve this. This first hour of oxytocin high will never return. We do not know the damage we can do if we disturb this. When I had my last child, my first and only boy, the midwives (my partners), missed the birth because he came so fast. My husband, who caught him with my direction, and I were marveling at him and totally bonding for about 5 or 6 minutes. When my partners came in, they were very excited and chatty since they had missed the birth. This completely disturbed me and must have stopped the oxytocin flow. I remember thinking that I wish they would go home or be quiet. It really was disturbing, though I loved them dearly. They were my partners and my best friends.

I love that Michel Odent tells us, “Do not disturb the mother.” I couldn’t agree more. One thing I learned to do is to take the chatty voices out of the room and go make a snack for mom or peanut butter sandwiches for the kids; anything just to give mom and dad private space with their newest family member. The placenta can wait. I would always ask mom to tell us if she feels any bleeding, and she always would let us know. Do all you can to protect the families’ sacred space while keeping an eye out for any complications, because they do happen occasionally. One baby we helped birth was breathing for several minutes and then stopped—she needed a little resuscitation. (The photo shown is of me and this little baby 21 years later holding the first issue of Midwifery Today—the cover of which shows her at birth.)

There has been some discussion on my Facebook page about the causes of autism. One theory is that a lack of bonding may be a cause. It has been found that children with autism are unable to manufacture oxytocin, so they have a severe shortage of it. Autistic children have trouble with eye contact and all the other little oxytocin enhancing things we do each day. I don’t think autism is a single-cause condition, but this may be a factor. Very few babies are able to really bond in the first hour with their moms in our medicalized world. This is something that can be changed.

That first hour or two, skin-to-skin connection with mother and baby is so vital. Baby has felt liquid for about nine months, and now skin is so very important. A quiet, oxytocin-flowing environment, with everyone using their voice as little as possible except for mom talking with baby, is the goal. Leave the cord intact so baby gets all of her blood. I just learned that at three minutes, the baby gets a huge dose of stem cells. What about all those babies whose cords have been amputated too soon? A suggestion is to wait until the mom asks for the cord to be cut. In my practice, this was usually after the placenta was out. With a short cord, let’s at least give it the 3 minutes for those stem cells to get transferred to baby. This is a great start to the life of a baby.

Four Stages of a Midwife’s Life

There is one more thing I want to add about fourth stage and this has to do with the four stages in the life of a midwife (or doula). First stage is the call to be a midwife. You are Passionate with a capital P. You are an aspiring midwife. You cannot get enough of birth talk, reading, conferences, plans, photos and now YouTube videos. You transition into being a student midwife whether you go to nursing school and become a CNM or if you go to midwifery school. In the USA, we can go to one of the excellent midwifery schools here or learn by apprenticeship or both. You are still very Passionate in second stage but the realities are beginning to sink in as well. Then in third stage, you are born into midwifery. You have your practice or job and do midwifery. You do, of course, keep learning from every birth you attend, but this is your life: midwifery. Hopefully it is a well-balanced life, but likely not. Then in fourth stage, you retire or semi-retire but once a midwife always a midwife. So you do other things to move midwifery forward. In my fourth stage of midwifery, I have started and continue to work on Midwifery Today magazine (the one you are reading now!), coordinate midwifery conferences and work hard to change the world of birth. Others become midwife educators, have midwife products or work with us on the Global Midwifery Council. There are so many things we need to work on in the birth world—we won’t run out of ideas for our ideals.

The life of a midwife—I wouldn’t trade it for any other life. How about you?

Jan Tritten

Jan Tritten is the founder and editor-in-chief of Midwifery Today magazine and a midwife who was in active practice from 1977–1989. She became a midwife in 1977 after the powerful homebirth of one of her daughters. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world! [ PHOTO BY ANDREA NOLL ]

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