An article was published this week about a mother dying hours after childbirth because her OB immediately pulled her placenta out after the baby was born. I wish this was a rare story, but that practice is absolutely commonplace.
I started noticing this trend of OBs (and sometimes midwives) beginning to pull on the cord to manually remove the placenta immediately after the baby was born about two years ago. Most often this was just done, without asking, they’d start tugging. They call it “providing traction.”
I witnessed this protocol, called a “managed third stage,” cause many problems, primarily hemorrhage (which they’d then stop with more pit), retained pieces of the placenta, breastfeeding problems, and infections. There was also emotional trauma of having that consent taken away in such a violent way. I’ve talked to many people who knew they’d hemorrhaged, but never knew why until we talked about this protocol, and they recognized it immediately as what had happened to them.
I was not up for witnessing that abuse happen on my watch ever again, so I got to work. I researched this protocol, learned why and how it began, and got input from multiple medical professionals.
I began talking to every client I had about the importance of insisting on an un-managed third stage. We discussed it prenatally, we brought it up again before pushing, and as those mamas held their babies in those precious first moments, I kept close watch on what was going on with the cord.
It took me some practice to figure out how to navigate the OB power dynamics and “convince” them to stop providing traction (but of course still check for bleeding after the delivery.) One OB asked me, “but how will the placenta come out without me pulling it out?” He has actually never seen a physiologic unmanaged third stage. I explained to him how placentas are “naturally” birthed, and he did step back and witness it!
Now, I am confident in my advocacy skills in ensuring that my clients do not receive this kind of care during this stage. My clients will not hemorrhage because of a hasty OB and breeched consent. I’ve actually begun training other doulas in the phrases that worked, and the prep that was needed, especially for doulas who serve marginalized communities who are at higher risk of poor treatment.
I grieve for the mother in this article, and I promise I will keep fighting with all I’ve got to ensure that my clients will not experience the same.
If you are pregnant or supporting a pregnant person and want to learn more about how to prevent this, please reach out! We all need to know more about the third stage.