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Active management of the third stage of labor refers to interventions that are taken to speed up the delivery of the placenta and reduce the risk of postpartum hemorrhage. This typically involves the administration of an oxytocic drug like Pitocin or Syntocinon to increase the contraction of the uterus and the use of techniques like fundal pressure and controlled cord traction to guide the placenta out of the uterus. Expectant management, on the other hand, is a more hands-off approach in which the placenta is left to detach and be delivered naturally, without the use of drugs, manual manipulations or interventions. This approach is usually used when there are no risk factors for postpartum hemorrhage and the mother and baby are both in good condition.

In this episode, we have Barbara Harper on the podcast with us. Barbara is a midwife, author, and the founder of WaterBirth International, which she founded exactly 40 years ago. She is a world-expert in birthing and to this day travels the globe educating obstetricians, nurses and midwives on physiologic birth.

Few mothers are given the opportunity to birth their placentas in the water, but is it really necessary to move women post-birth into a bed to complete the third stage (placental birth) of labor?  In order to explain whether this is the right choice for any mother and baby, Barbara walks us through the most common causes of postpartum hemorrhage, how to prevent it, and the critical understanding of newborn transitional physiology: what she says is literally the most important moment in any human being's life.

Is fundal massage necessary? When is the optimal time to cut the cord? What is the case for keeping the cord attached until the placenta is fully birthed? Is manual extraction of the placenta ever justified? These are some of the questions we answer in today's episode with Barbara.

Barbara Harper

Waterbirth International

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