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Labor and birth : 2nd and 3rd Stages (part 4) - After your Baby is Born - Cutting the cord

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After your Baby is Born

Shortly after your baby’s birth, the cord will be cut and your uterus will start to contract again to deliver the placenta.

The third stage

This is from the birth of your baby until the delivery of the membranes (the amniotic bag that surrounded your baby) and placenta. The placenta can be actively managed with the help of drugs or delivered without drugs, known as passive management or a physiological third stage. Your doctor will discuss these options with you before labor.

Cutting the cord

Once your baby has been delivered, it may be left for two to three minutes before it is cut. Allowing the cord to pulsate for a few minutes means your baby receives more blood from the placenta, which boosts his or her oxygen supply and blood volume. The cord will be clamped in two places, about 1 cm and 4 cm from the baby’s belly, and is cut with scissors between the clamps.

The umbilical cord will be clamped and cut, a few minutes after the birth, severing the link between your baby and the placenta.

Delivery of the placenta

How your placenta is delivered depends on your doctor. Many wait for it to happen naturally, but others offer an intramuscular (IM) injection of an oxytoxic drug in your thigh to make the uterus contract so that you can deliver the placenta and membranes quickly. Helping the uterus contract in this way reduces the risk of heavy bleeding occurring during the third stage, known as a postpartum hemorrhage (see Postpartum hemorrhage) and speeds up the delivery of the placenta, which can happen within 5 to 15 minutes after the birth of the baby. The risk of a postpartum hemorrhage occurring is the reason many units advise an active delivery. If you have a fibroid, active delivery will be advised because there is a heavy risk of bleeding.

Your doctor will place one of her hands just above your pubic bone to prevent the uterus from being pulled downward when she pulls on the cord. With her other hand, she will then apply gentle traction to the cord to help deliver the membranes and placenta. This is known as “controlled cord traction” (CCT).

The disc-shaped placenta, weighing around 1 lb 2 oz (500 g), has a network of blood vessels surrounding the umbilical cord in its center.

Delivering the placenta naturally

If you decide to deliver the placenta without drugs, known as a physiological third stage, this can take up to an hour. Your doctor will encourage you to bear down and you may find squatting helps. The doctor will check the placenta to ensure it’s complete and that none of it remains in the uterus, which can cause a postpartum hemorrhage.

How you feel after the birth

After the huge effort of giving birth, it’s common to have a physical reaction. Many women experience uncontrollable shaking or shivering, and some feel nauseous and may even vomit. In addition to your physical reaction, you are also likely to be feeling overwhelmed and emotional. Once you and your baby have been given the all clear, you should be given some quiet time alone to get to know each other.

Skin-to-skin contact with your newborn baby will help keep her warm—newborns don’t have very good temperature control—and will also help the two of you start bonding.

First checkups
Apgar score

At 1, 5, and 10 minutes, your baby’s breathing, pulse, movements, skin color, and responses are assessed. In South Asian and black babies, the color of the mouth, palms of the hands, and soles of the feet are checked. Each is given a score between 0 and 2, called the Apgar score. A total of 7 or more at 1 minute is normal; under 7 means help is needed.

Table
Apgar score210
Skin color Pink all overBody pink; extremities bluePale/blue all over
Breathing Regular strong cryIrregular, weak cryAbsent
Pulse/heart rate Greater than 100 bpmLess than 100 bpmAbsent
Movements/muscle tone ActiveModerate activityLimp
Reflexes after given certain stimuli Crying or grimacing stronglyModerate reaction or grimaceNo response

Postpartum hemorrhage

A postpartum hemorrhage describes the loss of up to 1 pint (500 ml) of blood after the delivery. This is often associated with a retained placenta, when the placenta remains in the uterus for a prolonged period of time, which is most likely to occur during a natural delivery of the placenta. It can also occur after an assisted forceps delivery; after a prolonged labor; or following a cesarean. Improvements in the treatment of this condition with antibiotics and blood transfusions has meant that the incidence of complications following a hemorrhage has fallen considerably over the years.

Your baby’s appearance

Newborn babies are usually surprisingly unattractive. Fortunately, as parents, we usually think they are beautiful. Newborns are covered in a waxy substance called vernix, together with amniotic fluid and blood from the birth canal. Babies who have passed meconium before the delivery may also have brown stained skin and nails.

In addition, newborn babies often have a molded, elongated head, with a swollen area on top known as a “caput,” which is due to the pressure on the baby’s head as it passes through the birth canal. Also, the nose may be squished to one side and the eyes may be swollen. Sometimes the genitals are swollen too. Rest assured that all of these features are temporary and within 24 hours or so the molding will work itself out and your baby will begin to look more like the baby you were expecting to meet.

Many babies are born with birthmarks that are referred to as “stork marks.” These are red birthmarks on the eyelids and at the nape of the neck, which fade in time.

Your newborn baby may have a squashed appearance, but this will smooth out within a day or two.

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