This information was first published in 2000 in the book Lotus Birth, and has been extensively updated and rewritten for 2009 and published in Sarah’s book Gentle Birth, Gentle Mothering available at www.sarahjbuckley.com

Copyright Dr Sarah Buckley, 2000

The medical approach to pregnancy and birth has become so ingrained in our culture, that we have forgotten the way of birth of our ancestors: a way that has ensured our survival as a species for millennia. In the rush to supposedly protect mothers and babies from misfortune and death, modern western obstetrics has neglected to pay its dues to the Goddess, to Mother Nature, whose complex and elegant systems of birth are interfered with on every level by this new approach, even as we admit our inability to understand or control these elemental forces.

Medical interference in pregnancy, labour and birth is well documented, and the negative sequelae are well researched. However, medical management of the third stage of labour- the time between the baby’s birth, and the emergence of the placenta-, to my mind, more insidious. At the time when Mother Nature prescribes awe and ecstasy, we have injections, examinations, and clamping and pulling on the cord. Instead of body heat and skin-to-skin contact, we have separation and wrapping. Where time should stand still for those eternal moments of first contact, as mother and baby fall deeply in love, we have haste to deliver the placenta and clean up for the next ‘case’.

This ‘management ‘ of the third stage, which has been taken even further in the last ten years, with the popularity of “active management of the third stage” (see below), has its own risks for mother and baby. While much of the activity is designed to reduce the risk of maternal bleeding, or postpartum haemorrhage (PPH), which is most certainly a serious event, it seems that, as with the active management of labour, the medical approach to labour and birth actually leads to many of the problems that active management is designed to address.

Active management also creates specific and potentially life-threatening problems for mother and baby. In particular, use of active management leads to a newborn baby being deprived of up to half of his or her expected blood volume. This extra blood, which is intended to perfuse the newly functioning lungs and other vital organs, is discarded along with the placenta when active management is used, with possible sequelae such as breathing difficulties and anaemia, especially in vulnerable babies.

Drugs used in active management have documented risks for the mother, including death, and we do not know the long-term effects of these drugs, which are given at a critical stage of brain development, for the baby.

Hormones in the third stage

As a mammalian species- that is, we have mammary glands that produce milk for our young- we share almost all features of labour and birth with our fellow mammals. We have in common the complex orchestration of labour hormones, produced deep within our “mammalian”, or middle brain, to aid us and ultimately ensure the survival of our offspring.

We are helped in birth by three major mammalian hormone systems, all of which play important roles in the third stage as well. The hormone oxytocin causes the uterine contractions that signal labour, as well as helping us to enact our instinctive mothering behaviours. Endorphins, the body’s natural opiates, produce an altered state of consciousness and aid us in transmuting pain: and the fight or flight hormones adrenaline and noradrenaline (epinephrine and norepinephrine- also known as catecholamines or CAs) give us the burst of energy that we need to push our babies out in second stage.

During the third stage of labour, strong uterine contractions continue at regular intervals, under the continuing influence of oxytocin. The uterine muscle fibres shorten, or retract, with each contraction, leading to a gradual decrease in the size of the uterus, which helps to “shear” the placenta away from its attachment site. Third stage is complete when the placenta is delivered.

For the new mother, the third stage is a time of reaping the rewards of her labour. Mother Nature provides peak levels of oxytocin, the hormone of love, and endorphins, hormones of pleasure for both mother and baby. Skin to skin contact and the baby’s first attempts to breast-feed further augment maternal oxytocin levels, strengthening the uterine contractions that will help the placenta to separate, and the uterus to contract down. In this way, oxytocin acts to prevent haemorrhage, as well as to establish, in concert with the other hormones, the close bond that will ensure a mother’s care and protection, and thus her baby’s survival.

At this time, the high adrenaline levels of second stage, which have kept mother and baby wide-eyed and alert at first contact, will be falling, and a very warm atmosphere is necessary to counteract the cold, shivering feelings that a woman has as her adrenaline levels drop. If the environment is not well heated, and/or the mother is worried or distracted, continuing high levels of adrenaline will counteract oxytocin’s beneficial effects on her uterus, therefore, according to Odent (1992), increasing the risk of haemorrhage.

For the baby as well, the reduction in fight or flight hormones, which have also peaked at birth, is critical. If, because of extended separation, these hormones are not soothed by contact with the mother, the baby can go into psychological shock, which, according to author Joseph Chilton Pearce, will prevent the activation of specific brain functions that is nature’s blueprint for this time. Pearce believes that the separation of mother and baby after birth is “the most devastating event of life, which leaves us emotionally and psychologically crippled” (Pearce 1992)

One might wonder whether the modern epidemic of “stress” – the term was invented by researchers in the early 20th century- and stress-related illness in our culture is a further outcome of current third-stage practices. It is scientifically plausible that our entire Hypothalamic-Pituitary-Adrenal (HPA) axis, which mediates long-term stress responses and immune function, as well as short-term fight-or-flight reaction, is permanently mis-set by the continuing high stress hormone levels that ensue when newborn babies are routinely separated from their mothers.

Michel Odent, in his review of research on the “primal period” (the time between conception and the first birthday), concludes that interference or dysfunction at this time affects the development of our “capacity to love”, which is particularly vulnerable around the time of birth, being connected hormonally to the oxytocin system. (Odent, 1998) Research by Jacobsen (1990, 1997)) and Raine (1994), among others, suggests that contemporary tragedies such as suicide, drug addiction and violent criminality may be linked to problems i