August 3, 2016
Volume 18, Issue 16
Midwifery Today E-News
“Third Stage of Labor”
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In This Week’s Issue



Save $6 on Wisdom of the Midwives!

MT storeThe second volume in the Tricks of the Trade series is packed full of useful ideas and techniques. You’ll learn about counseling as a tool in your birth kit, nutrition and healthy birth, herbs, homeopathy, Chinese medicine and more.

Plus, save $4 on the Postdates and Postmaturity Handbook, which will help you understand the myths and prevent the risks associated with postdate pregnancies and postmaturity syndrome.

Offers expire Aug. 15, 2016. No coupon needed. To order



Read about the third stage of labor!

MT store The Third Stage of Labor e-book is packed with information about the umbilical cord, the placenta and natural approaches to this phase of birth. This collection of 15 articles from past issues of Midwifery Today magazine includes “Placenta Accreta” by Marion Toepke McLean, “Cord Burning” by Kelly Dunn, “On Meconium at Home and Delayed Cord-cutting” by Naolí Vinaver, “Placenta Rituals and Folklore from Around the World” by Sarah J. Buckley and “The Problem Is Induction, Not Meconium” by Gail Hart. Buy your copy and have it with you at the next birth you attend!

Available on Amazon or on Smashwords in a variety of formats.



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Quote of the Week

Giving birth should be your greatest achievement not your greatest fear.

Jane Weideman


The Art of Midwifery

The mother [in third stage] needs to feel the contact with the baby’s skin, to look at the baby’s eyes and to smell the odor of her baby. Any distraction can bring her “back to our planet” and inhibit the hormonal peak. One cannot make a list of the countless distractions that can interfere during this phase of labor. Some of them are special to our society. For example, a woman has forgotten the rest of the world while discovering her baby. Suddenly a telephone rings. The mother will come back to our planet and will not release her vital peak of oxytocin.

Michel Odent
Excerpted from “Preventing Postpartum Hemorrhage,” Midwifery Today, Issue 105
Issue 105 is out of print. Check out our other back issues.



Midwifery Today Conferences

Birth Is a Human Rights Issue

Strasbourg conference Join us in Strasbourg, France, this October as we highlight the human rights violations around the world. You need to feel safe in your practice. Women need to feel safe in the way births are done. In addition to exploring these issues, our conference will inspire, encourage and refresh you. You are the key to changing the future of birth.

Learn more about the Strasbourg, France, conference.


Join us in Eugene, Oregon, next April!

Eugene conference You will learn from teachers such as Elizabeth Davis (pictured), Robbie Davis-Floyd, Anne Frye and Carol Gautschi. Planned classes include Using Rebozo in Prenatal Care, Shoulder Dystocia and Healing Trauma through Physiological Birth. Plan now to attend!

Learn more about the Eugene, Oregon, conference.



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Editor’s Corner

The Third Stage

Third stage is when a mom meets and loves her newly born baby. Is there any time that is more beautiful or precious than this time when a mom and her baby are skin to skin for the first time? The oxytocin flowing combats the risk of hemorrhage when birth workers don’t interfere unnecessarily. Even when undisturbed, hemorrhages do happen, and when one does, the best and quickest way to handle this is to use the placenta, membranes and/or cord.

If the placenta is still in the mother, go for the membranes or cord. If the cord hasn’t stopped pulsating or if mom wants to do a lotus birth, the membranes are what to use. Get a piece with a hemostat, wipe it off and put it into mom’s cheek. During a “Tricks of the Trade” session at the last conference, a midwife shared about a woman who wanted more and more of her raw placenta right after a birth. The midwife thought she may have consumed as much as a cup of placenta. This led me to believe sometimes more than a quarter-size piece may be needed.

A small piece of cord inserted in the cheek can bring a placenta that shows no sign of coming on its own. A three-quarter inch piece should do the trick.

There is so much right at hand that can be used for complications if we just try to do things more naturally. Be sure to have the Pitocin handy just in case natural ways don’t work.

Toward Better Birth!

— Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. 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, or join her online, as she works to transform birth practices around the world.

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Please support our advertisers
BirthWorks International Conference: “Finding the TRUTHS about Birth”
advertiserJoin us! October 14–16, 2016, Mt. Laurel, NJ. Program includes pre-conference October 13 full day with Nils Bergman, MD, of South Africa, film “IN UTERO,” An Evening with Ina May, 5Rhythms Dancing. Waterpark, Historic Philadelphia. Birth is instinctive. All women are born knowing how to give birth. Amazing line-up of high profile speakers! Visit our website


Conference Chatter

Fiji Conference Report and Upcoming Events

We had an amazing conference in Fiji. The midwives there were receptive to all they were being presented. I felt like we were able to do more there with regard to birth change than we have at all 75 previous Midwifery Today conferences combined. The midwives took an oath to basically put into practice all they learned at the conference, the first one being to uphold physiological birth.

We are putting the final touches on our program for our April 5–9, 2016, Eugene, Oregon, conference. Penny Simkin, Elizabeth Davis, Missy Cheyney, Gail Hart, Chandler Marrs, Jill Cohen, Marion Toepke-McLean and many others will join us. We hope you will too! View the Eugene program on our website.

Strasbourg, France, is our next full conference. The theme is “Birth Is a Human Rights Issue.” We have already done this theme once before in this city, where the European Human Rights Court resides, but sadly it needs to be done again.

On September 9, 2016, we have a one-day retreat in Sebastopol, California. This program includes classes by Elizabeth Davis, Gail Hart, Eneyda Spradlin-Ramos and yours truly. This will be a nice intimate event on a permaculture farm! Check out the whole program here.

— Jan Tritten

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Please support our advertisers
New Edition of Clinical Practice Guidelines for Midwifery & Women’s Health
advertiserClinical Practice Guidelines for Midwifery & Women’s Health, Fifth Edition is an easy-to-use quick reference guide for midwives and women’s healthcare providers. Completely updated and revised to reflect the changing clinical environment, it offers current evidence-based practice, updated approaches, and opportunities for midwifery leadership in every practice setting. Save 25% when you order online with coupon code CPGMT at our website.


Featured Article

Third Stage of Labor: Hands Off and Have Patience!

Many families are surprised when I say that I do not touch the baby if all is well, and I do not clamp or cut the umbilical cord until after the placenta has been birthed. They are always curious to know why I do this, since the vast majority of obstetricians clamp and cut the cord immediately, and even a good number of homebirth midwives clamp and cut the cord before the placenta has been birthed.

So why do I have this rule? I hold fast because there is just no need for midwives to do anything during the third stage in most labors. Baby does not need my hands on him. Baby does not need me to touch him with my stethoscope. Baby simply needs to be held and loved on by his mother.

I also do not touch the cord unless I am feeling the pulse for the baby’s heart rate. There is just no reason to touch it. I calmly wait for the birth of the placenta before I touch much of anything. This is a great time to take some photographs of the happy family or fill in some details about the labor and birth in the client’s chart.

Ever since taking my first neonatal resuscitation course with Karen Strange years ago, I have held onto this time during third stage as incredibly sacred for the family as a whole, but especially for mom and baby. Mom is meeting her baby on the outside for the very first time. She gets to drink in his sight and smell. She gets to stroke his cheek, count fingers and toes, marvel at the mere fact that she just gave birth to this perfect human being. This is the last moment in which a midwife needs to interfere.

With our eyes we can silently assess baby’s muscle tone, color and response to his mother’s voice and touch. With our ears we can assess sounds—gurgles, sneezes, coughs and cries. Sometimes it can be hard to not do anything. When those moments creep up on me, I try to remember that under most circumstances mom and baby will do best if not disturbed. I remember how precious those moments were to me—and how they were stolen from me with all but one of my children. If we can step back and think about what we would want to happen in this space and time if we were the ones giving birth, it can have a positive effect on how we manage the third stage.

Christy Fiscer
Excerpted from “Third Stage of Labor: Hands Off and Have Patience!,” Midwifery Today, Issue 100
View table of contents / Order the back issue


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Placenta rituals, remedies and recipes…

MT store …are what you’ll find in Placenta: The Gift of Life. Read this book to discover the various ways placentas have been used by people around the world and throughout the ages. You’ll also find 15 recipes that will show you how to use the placenta in ointments, essences and other remedies for a variety of ailments. To order



Thinking about becoming a midwife? Do you know someone who is?

MT store Paths to Becoming a Midwife: Getting an Education is just what any aspiring midwife needs and would be a much appreciated gift. The fourth edition of this book includes several new articles on the various midwifery philosophies, information on becoming an apprentice, dozens of updated articles, and a directory of more than 150 schools, programs and other resources. To order



Let Miss Margaret inspire you!

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A way to work through grief and loss

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Website Update

Read this article excerpt from the current issue of Midwifery Today magazine, now on our website:

  • Hands On, Hands Off: Midwifing the Inner Life of Women—by Sister MorningStar

    Excerpt: [I asked Silje:] “What would your ideal birth look like? What would you be doing and who would be there and what would they be doing?” At first she told me things that have to do with safety and I could hear the anxiousness in her voice. She began to describe medical back-up plans, “in case the midwives say that transport is necessary.” I listened. Then, I asked again. “Assuming all is well, what would your ideal birth look like?”


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Birth Q&A

Q: To midwives: What is the most common third stage complication you run into and how do you remedy it?

— Midwifery Today

A: Extra bleeding. I give a tincture I make called anti-bleed, which contains the following: black cohosh, blue cohosh, yarrow, shepherd’s purse, bayberry, and cotton root bark.

— Deb Phillips

A: Though not usually a complication, some mothers feel the third stage is longer than they remember or read it would be, and they want to be “done.” I use patience, focus on initiating breastfeeding, and help mom into the squatting position if necessary to help encourage the placenta to release. No tugging or pulling required.

— Juanita Michelle Gober

A: I’ve never had a third stage complication because I leave things alone! I don’t worry about how long it’s taking, as long as the tone is good and there is no bleeding or bogginess. It can take hours and hours if need be. A catheter might be indicated if the woman has no sensation to pee (I personally had this issue after I birthed my second). Put baby to breast. I believe most PPHs are caused by poor management. Abnormal placentation is truly rare.

— Coral Daphne

A: Complications are rare, but of course excess bleeding is the most common. This is usually easily handled with correct massage or compression. The length of third stage is not particularly relevant, as long as there is finally a normal separation and expulsion.

The most common complication is not actually recognized; it is the interference from all those well-intentioned people who want to talk to the mother and chat and interrupt the mother and the baby as they are trying to bond.

All the routines should be postponed unless there is an indication of trouble. The new newborn exam, putting hats and wrapping the baby, attempting to make the baby nurse, etc., should be postponed for at least an hour or more.

— Gail Hart


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