The Rights Of Women When Giving Birth

For more than 60 years, it has been the standard of care to try to speed up childbirth with drugs, or to perform a cesarean section if labor was seen as progressing too slowly. Now a new set of recommendations is changing the game. In February, the World Health Organization released a set of 56 recommendations in a report called Intrapartum Care for a Positive Childbirth Experience. One key recommendation is to allow a slow labor to continue without trying to hurry the birth along with drugs or other medical interventions. The paper cites studies showing that a long, slow labor — when the mother and baby are doing well — is not necessarily dangerous.

Adopting a woman-centred philosophy and a human-rights based approach opens the door to many of the care options that women want such as the right to have a companion of choice with them throughout the labour and birth as well as the freedom to move around during the early stages of labour and to choose their position for birth. These recommendations are all evidence-based, optimize health and well-being, and have been shown to have a positive impact on women’s experience of childbirth.

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For health care facilities, in addition to providing the clinical care specific to labour and childbirth, it also means making sure that women are treated with respect and that they have the very basics of oral fluids and food during labour and childbirth. Continuity of care, regular monitoring and documentation of events as well as clear communication between medical practitioners and clients are essential, as is ensuring that a referral plan is in place should more advance medical care become necessary. These are all essential elements of good quality labour and childbirth care that every woman and her baby should receive.

This guideline complements the recent WHO guidelines on the provision of antenatal care for a positive pregnancy experience.The guideline contains 56 evidence-based recommendations detailing the clinical and non-clinical care that is needed throughout labour and immediately afterwards for women and for newborns. One of the key new recommendations in this guideline recognizes that every labour is unique and that they do not all progress at the benchmark rate of 1 cm/hour of cervical dilatation.

World Health Organization. (2018). New Guidelines Establish The Rights Of Women When Giving Birth.;jsessionid=8CC8B938A928347D8BB634AA7BDBEB21?sequence=1


Do not intervene to speed up birth unless real risks involved

Medical staff and midwives should not intervene to speed up a woman’s labour unless there are real risks of complications, says the World Health Organisation (WHO), warning that too many are not having the experience of natural childbirth that they want.

Image result for positive natural birthing experience  african mama at home skin to skin

New guidance from the WHO overturns decades of previous advice, which said that labour which progressed at a slower rate than 1 cm of cervical dilation per hour in the first stage was risky. Women are often given the oxytocin to speed up labour and end up with epidurals because of the pain, followed by forceps or vacuum deliveries and in some cases a caesarean section.

Many women want a natural birth and prefer to rely on their bodies to give birth to their baby without the aid of medical intervention and research. Even when a medical intervention is wanted or needed, the inclusion of women in making decisions about the care they receive is important to ensure that they meet their goal of a positive childbirth experience (WHO).

Every year there are about 140 million births, most of which are uncomplicated. Yet women are increasingly being subjected to medical interventions in the name of risk-avoidance, which may be unnecessary and unwelcome to them, says the WHO. The caesarean section rate in particular is too high around the world and as major surgery, carries risks of its own.

Adopting a woman-centred philosophy and a human-rights based approach opens the door to many of the care options that women want such as the right to have a companion of choice with them throughout the labour and birth as well as the freedom to move around during the early stages of labour and to choose their position for birth. These recommendations are all evidence-based, optimize health and well-being, and have been shown to have a positive impact on women’s experience of childbirth.

World Health Organization. (2018). WHO recommendations: intrapartum care for a positive childbirth experience. Retrieved from


Natural Childbirth Movies to Watch

Birth videos can be very informative, educational and uplifting to watch. Most of these clips contain nudity and some show everything – so please use your judgement when and where you watch the videos.

  1. The Business of Being Born. This is one of the best-known films about childbirth. Produced by and featuring Ricki Lake, it weaves together the story of Ricki’s second pregnancy, the work she does with her midwife to prepare for an unmedicated home birth, and an examination of how mainstream childbirth is managed in America.
  2. Laboring Under an Illusion: Mass Media Childbirth vs. The Real Thing. Anthropologist and childbirth educator Vicki Elson examines chidlbirth myths and reality.
  3. Woman to Woman. This is a film about natural childbirth and activism. It’s available on Amazon Instant.
  4. Orgasmic Birth. This film experiences the intimacy of childbirth through couples sharing their stories about childbirth as a sensual experience. With insights from legendary midwife and educator Ina May Gaskin.
  5. It’s My Body, My Baby, My Birth. This film follows 7 expecting mothers through the emotional journey they each make toward natural childbirth. The film also follows midwives and childbirth educators.
  6. Pregnant in America. Young, expecting couple Steve and Mandy Buonaugurio decide to bring their baby into the world outside the hospital system. They travel around the country investigating American maternity care. You can watch this 2008 documentary on Hulu.
  7. MicrobirthA documentary on the latest research on the origins of the microbiome; how microscopic events during childbirth have lifelong consequences for the health of our children. (60 mins).
  8. Who’s Afraid of Designer Babies?
  9. The Face of Birth. The Face of Birth is an Australian documentary that examines contemporary birthing practices through the personal stories and journeys of women who choose to have their babies at home. Featuring some of the world’s top childbirth experts, The Face of Birth gives us the ‘big picture’ of the importance of respecting and protecting a woman’s right to choose how, where and with whom she gives birth. NOW AVAILABLE via download and DVD at
  10. Birth As We Know It. Now in 57 countries since its release in 2006, Birth As We Know It is receiving global recognition as the most comprehensive guide to Conscious Birth in the world, because it delivers a powerful transmission of what it really takes to give birth consciously and gracefully.


Pregnancy & Birth Resources In Cape Town







Dr Lin 021 761 7742 Plumstead
Tamara 082 254 0163 Kloof Rd
Shaul Friedman 021 696 9778 Rondebosch East
Vicky Hindmarch 021 531 8644 Pinelands
Arnold Erasmus email 074 100 8954 Lao-Kung Observatory

Antenatal Classes

Sandy Standish email Birthing  Naturally Vredehoek/Muizenberg
Susan Lees 021 761 9623 082 321 0177 Plumstead
Angela Wakeford 073 166 0876 Fish Hoek
Joann Lugt 021 531 5422 084 879 8511 Birth and Babies for Beginners Pinelands
Connie Fraser email 021 465 0346 Vredehoek
Irene Bourquin email 021 852 3040 Somerset West
Robyn Sheldon email 021 712 0298 Mama Bamba
Amanda Perkins email 079 883 0119 Mama Bamba
Emma Numanoglu 083 455 8338 Me a Mama Rondebosch
Al-Nisa Maternity Home email 021 696 8892 Al-Nisa Maternity Home Rondebosch
Kim Young 083 085 6645 Hypnobirthing Plumstead – Birth Options

Birth Pool Hire

Lana Petersen email 073 514 9754 Birth Works ottery and southern suburbs
Gayle Friedman email 082 958 4801 Birth Works gardens central and northern suburbs
Natasha Stadler email 081 271 0296 Home Water Births Winelands and Overberg


Ruth Ehrhardt email 078 557 9070 Homebirth
Lana Petersen email 073 514 9754 LaLiLu  Doula Care
Sarah Meder email 076 100 8544 Birth Ways
For a full list of Doula’s in  the W.Cape

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100 Best Herbs For Health And Wellness

Herbal remedies have been used for thousands of years and although they’re natural, they can have side effects so it’s important that you learn about  side effects, such as digestive problems or headaches and safety, for instance during pregnancy.  People are turning to herbs in their millions for a natural way to stave off depression, cure skin diseases, get a good night’s sleep and keep their bodies and minds in tip top condition. Give your vision and hearing a boost by taking these herbs.

  1. Ginkgo Biloba: Ginkgo has been attached to many potential benefits, but perhaps one of the most significant is its ability to improve blood flow to the eyes especially in those suffering from macular degeneration. It can also be valuable to your ears as numerous studies have suggested it can help prevent tinnitus and inner ear disturbances as well as a number of other conditions.
  2. Bilberry: A relatively unknown but powerful antioxidant, bilberry has a number of positive health effects for the brain and heart. It can also help to protect the retina and improve range and clarity of vision.
  3. Passionflower: If staring at a computer screen or reading in dim light has your eyes strained, try taking a passionflower supplement. It can help relax the small blood vessels in the eye and make seeing easier.
  4. Goldenseal: Sties and conjunctivitis can be irritating and embarrassing conditions. Take somegoldenseal to help reduce the inflammation associated with these conditions and get you on the road to recovery.
  5. Aspalathus: This South African herb contains a number of antioxidants that are similar to those found in Bilberry. These can boost your eye health while giving you overall improved immune function.
  6. Mahonia Grape Extract: The sun can have an immensely damaging effect on the eyes, but this herb can help reduce the impact of sun damage while strengthening the retina, slowing eye aging and maintaining better overall eye health.
  7. Bilwa: Found in the sub-Himlayan forests, this fruit has been used in India to help treat painful eye conditions like sties and conjunctivitis.
  8. Mullein flower: This flowering plant can be a natural way to help rid yourself of an ear infection as it acts as a natural bactericide when condensed to oil form.

Mental Health and Function

Keep your mind sharp, alert and in good health with a little help from these plants.

  1. Kava kava: This herb can help calm your anxieties by binding to brain receptors that promote relaxation.
  2. St. John’s Wort: Those with mild to moderate depression may find some relief with this herb. Numerous studies have been done on it, most finding that it can be as effective as some prescription drugs at treating depression. Those with more severe depression should, of course, consult a medical professional.
  3. Valerian: Lull your body into a restful sleep with a natural remedy instead of prescription pills. Valerian has been shown to be as effective as traditional sleeping pills, while eliminating some of the more harmful side effects associated with them.
  4. Bacopa: Used in India for several thousand years, this flowering plant has been said to improve memory, learning and cognition. Studies have shown that it can do little to improve your old memories but does have an affect on newly acquired information, so start taking it sooner rather than later.
  5. Ginseng: Many people have heard of the herb ginseng, but few know that there have been numerous studies done to document its effects. These studies seem to suggest that there can be some benefits of taking it that include improved memory and other mental performance and a whole host of other effects ranging from immune system stimulation to lowered cholesterol.
  6. Holy Basil: Also known as tulsi, this herb is not usually used in cooking like its cousin, but instead can help reduce the effects of stress on the body by inhibiting cortisol.
  7. Chamomile: Generally known as a relaxing herb, chamomile tea can be a great way to wind down after a stressful day and ease stress. Some also use it to calm nerves or relieve menstrual cramps.
  8. Suma: This rainforest plant can in some people help to normalize body systems and reduce the effects of stress.
  9. Brahmi: Give this Indian remedy a try to help boost your brain function and information retention.
  10. Gotu Kola: Commonly used in India, this herb can help to improve cognitive function and reduce anxiety, helping you think more clearly and calmly.
  11. Sage: Modern research has shown that sage can actually help make you wiser, improving memory and reducing inflammation.
  12. Kudzu: Feel like you’d like to have better self control when it comes to drinking and killing all those brain cells? This herb can help you to curb your appetite for booze by helping alcohol more quickly get to the part of the brain that tells you enough is enough.
  13. Catnip: Not just for cats, this common herb when eaten can help reduce anxiety and produce an overall sedated effect.

Digestive and Urinary Systems

Use these herbs to ensure that your plumbing stays in good condition.

  1. Licorice: You may love the taste of licorice but might not have known about the beneficial health effects it can have. It can soothe and relax gastrointestinal tissues, helping ease the pain of ulcers and acid reflux and has even been shown to help increase bile production.
  2. Milk Thistle: Give your liver some help filtering out all those toxins by taking some milk thistle. It can help improve the regeneration of liver tissue and regulate liver function as demonstrated in testing done at radiology tech schools nationwide.
  3. Peppermint Oil: A little dab of peppermint oil will do you to help relax the smooth muscles of your colon, stopping cramps and constipation that can be common symptoms of irritable bowel syndrome.
  4. Ginger: An upset stomach is never fun to deal with, but ginger may be the solution that you’re looking for. Ginger helps slow the production of serotonin, a major factor in the nauseated feeling you get when you are motion sick or experiencing pregnancy sickness.
  5. Senna: If you’re feeling constipated, this herb may work well as a natural laxative to get things moving again.
  6. Gentian: This super bitter herb has been used for generations to treat digestive problems. Its bitter tastes stimulates the digestive system, making it easier to get food through your system problem free.
  7. Uva Ursi: Try out this herb for a great natural way to help prevent getting bladder infections.
  8. Aloe: While great for healing burns and skin irritation when applied topically, this plant can act as a helpful laxative when consumed.
  9. Gamma Orizanol: Give this remedy a try if you want to help calm an upset stomach.
  10. Rose Hips: These small berries serve a dual purpose helping to reduce bladder infections and to fight constipation.
  11. Agrimony: If your whole digestive system needs a lift, try out this herb, said to improve stomach, liver, kidney and gallbladder function.
  12. Anise: This licorice-flavored herb can help prevent the accumulation of painful gas in the stomach and intestines.
  13. Celery Seed: Those having a little difficulty urinating may want to try this natural remedy out, cited for its diuretic properties.

Physical Appearance

Help yourself look good at any age with these powerful herbs.

  1. Burnet: The leaves of this plant have been used for thousands of years in China, and can help treat several skin conditions as well as reducing the inflammation of hemorrhoids and helping heal burns.
  2. Burdock: Used all over the world, this substance helps combat hair loss, treats dandruff, and helps skin problems.
  3. Calendula: Great for all around skin care, this herb can treat everything from acne to chapped lips.
  4. Comfrey: Use the leaves and roots of this plant to soothe skin irritations and promote connective cell growth.
  5. Plantain leaf: Because it has many soothing elements, this plant is one of the best remedies for cuts, skin infections, and chronic skin problems.
  6. Red Clover: If you’ve tried everything to get rid of your acne, why not give this natural acne and skin clearingremedy a try?
  7. Sassafras Leaf: Said to purify and cleanse the body, this plant can be a helpful tool in getting acne under control.
  8. Solomon’s Seal Root: Make a wash out of this plant to help control skin problems and blemishes.
  9. Spikenard: Acne, pimples, blackheads, and rashes don’t stand a chance against this inflammation fighting herb.

Heart and Circulatory System

Give your heart and the blood throughout your body some healthy help with these herbs.

  1. Garlic: Garlic is a powerhouse when it comes to heart health. Regular usage has been shown to prevent cardiovascular disease and lower high blood pressure. In addition, studies suggest that it might help prevent cancer, kill bacteria, and even improve levels of t-cells in AIDS patients.
  2. Hawthorn: The berries of this flowering shrub are great for the heart, by helping to open up the coronary arteries, lowering blood pressure, or slowing a rapid heart rate. Users will see the best effects after six months or more of taking the supplement.
  3. Guggul: Guggul is thought to bind to cholesterol in your gut so that you eliminate it before it enters your bloodstream, helping reduce your overall cholesterol and feel better.
  4. Horse chestnut: Help prevent those unsightly varicose veins by taking some horse chestnut. Aescin and other compounds in the herb can help bulk up weak capillaries and veins, making them less prone to swelling and pain.
  5. Cinnamon: If you’re worried about the health of your circulatory system, consider adding a littlecinnamon to your diet. Cinnamon has been shown to reduce blood sugar and help lower cholesterol.
  6. Dandelion: Dandelions are more than just an annoying weed, they can also be an effective way to help control high blood pressure. Researchers think it works like many prescription medicines, decreasing your blood volume and thereby your blood pressure.
  7. Angelica root: Traditional wisdom places this herb as a great heart strengthener, especially for those suffering from heart related conditions.
  8. Coriander: The seeds of the cilantro plant can help build and strengthen your circulatory system and make for a stronger, healthier heart.
  9. Cayenne: Containing capsicum, cayenne can help normalize blood pressure, increase the elasticity of blood vessels, and even slow bleeding.
  10. Motherwort: This plant has a long history of use and contains the alkaloid leonurine which can have a relaxing effect on smooth muscles like those found in the heart.
  11. Gynostemma: This herb has been shown in laboratory studies to have a direct effect on the circulatory system, strengthening the heart and helping wounds heal more quickly.

Pain and Inflammation

Don’t suffer through pain and inflammation, try these remedies instead.

  1. Arnica: The yellow flowers of this plant provide powerful anti-inflammatory properties. Apply it to the skin to help reduce the pain and swelling of bruises, strains and sprains.
  2. Feverfew: Several studies have confirmed that feverfew can help prevent and treat migraines. It works by reducing the amount of serotonin in the body and relaxing constricted blood vessels in the head.
  3. Willow Bark: A component of traditional aspirins, willow bark can be a wonderful way to naturally reduce minor aches and pains.
  4. Devil’s Claw: Native to southern Africa, this long-used remedy can be a helpful agent in reducing inflammation as well as back and neck pain.
  5. Chinese Skullcap: Part of the mint family, this herb can help reduce stress headaches, the effects of PMS and even insomnia.
  6. Marjoram: Great for general aches and pains, this common herb can be even more effective when combined with chamomile or gentian.
  7. Thyme: Many use thyme in their cooking without being aware that it can help fight infection, reduce the pain of migraines and help clear out the lungs.
  8. Meadowsweet: Meadowsweet contains many of the chemicals used to make aspirin in its roots and when chewed can prove a helpful remedy for headaches.
  9. Cat’s Claw: While few definitive studies have been done, many believe this herb can reduce general inflammation and boost the immune system.
  10. Wood Betony: This attractive woodland plant does more than just look pretty, it can also be used to reduce the pain associated with headaches.
  11. Witch Hazel: Those suffering from hemorrhoids especially will appreciate the anti-inflammatory properties of this herb.

Illness Prevention and Treatment

Check out these herbs and plants to help keep you in general good health.

  1. Ephedra: One of the oldest cultivated medicinal herbs, Ephedra is most commonly used to help treat and prevent colds. It works by dilating the bronchial tubes through the release of adrenaline to be especially useful to those suffering from allergies and asthma. Long term usage can be harmful, however, so take it with care.
  2. Echinacea: Give your immune system a boost by taking some echinacea. It activates the body’s natural defense mechanism, white blood cells, and helps your body prevent and fight off harmful infections and bacteria.
  3. Astragalus: The Chinese have known about and used this herb for thousands of years for a variety of different ailments. Recent studies have shown that it may have a very real effect on the immune system, increasing immune activity and effectiveness.
  4. Elderberry: Keep the flu at bay by chomping down on this berry. Rich in vitamins A and C, it’s been shown to prevent the flu virus from spreading to healthy cells and cuts recovery time in half.
  5. Andrographis: Help keep your colds short and sweet by taking a little bit of this herb. Studies have shown it can help reduce symptoms like fatigue, sleeplessness, sore throat, and runny nose up to 90%.
  6. Kelp: Kelp is very high in iodine which is a natural infection fighter. As a bonus, it contains substances that are beneficial to hair and nails.
  7. Yarrow: While too much yarrow can be quite dangerous, a careful amount can be a great assistor in breaking a fever and fighting off a cold or flu.
  8. Boneset: An infusion of this herb can help you to more quickly fight off a cold.
  9. Elder: When you feel a cold or the flu coming on, enjoy some herbal tea made from this plant. If you are growing it at home, never eat the green parts of the plant as they are poisonous.
  10. Pleuresy root: Sometimes also called butterfly weed or Indian paintbrush, this variety of milkweed can help you get more out of your coughs when you have a cold or soothes some of the inflammation as well.
  11. Pau d’arco: This Brazilian herb is thought to be an all around booster to your immune system.
  12. Maitake: Check out this mushroom, common in asian medical practice for a jump start for your immune system as well as for help with blood pressure and cholesterol.
  13. Horehound: Sore throats and coughs can be remedied by making a tea of the leaves of this plant.

Diseases and Conditions

While not cure-alls, these herbs and plants can help reduce the symptoms and severity of a variety of medical conditions.

  1. Khella: Check out this Middle Eastern herb for a little help on preventing those asthma attacks before they start. It dilates your bronchial tubes and relaxes the muscles that spasm during an attack, helping keep you breathing easy.
  2. Gymnema: Help reduce the effects of your diabetes symptoms by stimulating your pancreas to pump out more insulin with this herb. Used for thousands of years, recent preliminary studies have shown that it can have a big impact on reducing blood sugar.
  3. Eyebright: Don’t let hay fever leave you knocked out with red eyes and a runny nose. This herb can help make your immune system less reactive to airborne allergens, making your life a little easier during allergy season.
  4. Lemon Balm: While there is no cure for herpes, there are ways that you can help make it a little more bearable, both in it’s genital and cold sore forms. Lemon balm can help reduce itching, swelling, and tingling while speeding up healing.
  5. Rosemary: While rosemary itself may not have any proven medical benefits, the application of it to other foods can. Studies have shown that rosemary helps prevent the formation of carcinogens caused by grilling foods.
  6. Wild Cherry: Wild cherry isn’t just a soda flavoring, it can also help with asthma by loosening phlegm in the chest and throat and reduce inflammation of tissues.
  7. Fenugreek seed: Try this multipurpose remedy for help with allergies, coughs, headaches and sore throat.
  8. Forsythia: If you fear you may have picked up lyme disease, this flowering scrub may offer you some help by providing antibacterial properties to weaken the disease.
  9. Boswellia: This herb relieves symptoms of both osteoarthritis and rheumatoid arthritis, and can even work well for those who reacted negatively to other natural treatments.
  10. Turmeric: Those suffering from painful joints due to arthritis may be well advised to add a littleturmeric into their diets. This spice, used in curry, contains curcumin, a powerful anti-inflammatory substance which can help reduce the pain and swelling.
  11. Yucca Root: Yucca root reduces inflammation of the joints, making it a valuable remedy for arthritis.
  12. Nettle: Extracts of this plant have been used to treat conditions like arthritis, anemia and hay fever.

Reproductive Health

Ensure that your reproductive organs are in good health with these herbal remedies.

  1. Sea Buckthorn: Women suffering from vaginal dryness may find a natural cure in this remedy. It contains palmitoleic acid which helps hydrate mucus membranes and keeps skin moisturized.
  2. Black Cohosh: Make menopause easier by checking out this herb, used by some Native American groups. It contains plant estrogens which can help regulate and balance your rapidly changing hormones.
  3. Chaste Berry: The small, peppery-tasting berries of this plant can offer some help to women coming off birth control or those who just need a little assistance in regulating their hormones and menstrual cycles.
  4. Dandelion: If you suffer from a large amount of fluid retention around your time of the month, consider taking dandelion. It has natural diuretic properties that help eliminate excess fluids.
  5. Dong Quai: This plant has estrogenic properties making it a good choice for women who want to balance their hormones and ease common PMS symptoms. Be advised that it can take up to a year to see results from taking it.
  6. Raspberry Leaf: Pregnant women should check with their doctors before taking this herb, but it’s generally considered safe and can help ease the painful process of labour.
  7. Saw Palmetto: Get some help keeping your prostate in good health with this herb. It reduces the symptoms of an enlarged prostate, in some cases as much as a prescription medication, though it may not work for every man.
  8. Daminana Leaf: This multipurpose herb can help deal with sexual dysfunction issues in both men and women as well as helping to reduce hot flashes associated with menopause.
  9. Sarsaparilla: With effects similar to the male hormone testosterone, this herb can be a great way to stimulate the sex drive in both men and women.
  10. Beth Root: Some have seen balancing effects on the hormones with this herbal tincture, leading to normalized menstrual bleeding, reduced effects of menopause and easier pregnancy.

The hormones of Pregnancy and Childbirth


Hormones play a huge role in pregnancy and in the birth process. It can be especially helpful to know about the main hormones involved with reproduction. By understanding how these hormones function during a natural birth, women can learn how to work with them when they are in labour. At the same time, women can make more informed decisions with their healthcare professionals about medical interventions that can disrupt the natural role of hormones.The correct balance of hormones is essential for a successful pregnancy.  Hormones act as the body’s chemical messengers sending information and feeding back responses between different tissues and organs.  Hormones travel around the body, usually via the blood, and attach to proteins on the cells called receptors – much like a key fits a lock or a hand fits a glove.  In response to this, the target tissue or organ changes its function so that pregnancy is maintained.  Initially, the ovaries, and then later, the placenta, are the main producers of pregnancy-related hormones that are essential in creating and maintaining the correct conditions required for a successful pregnancy.Here is an overview of hormonal interactions.The hormones of birth include estrogen and progesterone, oxytocin, beta-endorphins, prolactin and catecholamines (epinephrine/adrenaline and norepinephrine/noradrenaline.

The early stages of pregnancy

Following conception, a new embryo must signal its presence to the mother, allowing her body to identify the start of pregnancy.  When an egg is fertilised, it travels though the female reproductive tract and on day six implants into the womb releasing a hormone called human chorionic gonadotrophin in the process.  This hormone enters the maternal circulation and allows the mother to recognisethe embryo and begin to change her body to support a pregnancy.

Human chorionic gonadotrophin can be detected in the urine as early as 7-9 days after fertilisation and is used as an indicator of pregnancy in most over-the-counter pregnancy tests.  It is partly responsible for the frequent urination often experienced by pregnant women during the first trimester.  This is because rising levels of human chorionic gonadotrophin causes more blood to flow to the pelvic area and kidneys, which causes the kidneys to eliminate waste quicker than before pregnancy.  Human chorionic gonadotrophin passes through the mother’s blood to the ovaries to regulate the levels of the pro-pregnancy hormones, oestrogen and progesterone.

The role of progesterone and oestrogen during pregnancy

High levels of progesterone are required throughout pregnancy with levels steadily rising until the birth of the baby.  During the first few weeks of pregnancy, progesterone produced from the corpus luteum (a temporary endocrine gland of the ovaries) is sufficient to maintain pregnancy.  At this early stage, progesterone has many diverse functions which are vital to the establishment of pregnancy, including:

a) Increasing blood flow to the womb by stimulating the growth of existing blood vessels
b) Stimulating glands in the lining of the womb (the endometrium) to produce nutrients that sustain the early embryo
c) Stimulating the endometrium to grow and become thickened, producing the decidua, a unique organ that supports the attachment of the placenta and allowing implantation of the embryo
d) Helping to establish the placenta.

As the placenta forms and grows, it develops the ability to produce hormones.  The cells that make up the placenta, known as trophoblasts, are able to convert cholesterol from the mother’s bloodstream into progesterone.  Between weeks 6-9 of pregnancy, the placenta takes over from the ovariesas the main producer of progesterone.  As well as being vital to the establishment of pregnancy, progesterone also has many functions during mid to late pregnancy, including:

a) Being important for correct foetal development
b) Preventing the muscles of the womb contracting until the onset of labour
c) Preventing lactation until after pregnancy
d) Strengthening the muscles of the pelvic wall in preparation for labour.

Although progesterone dominates throughout pregnancy, oestrogen is also very important.  Many of the functions of progesterone require oestrogen and in fact, progesterone production from the placenta is stimulated by oestrogen.  Oestrogen is made and released by the corpus luteum of the ovaries and then later, the foetal-placental unit, where the foetal liver and adrenal glands produce the hormone oestriol (an oestrogen often used to determine foetal wellbeing in pregnancy), that is passed to the placenta where it is converted into other oestrogens.  Levels of this hormone increase steadily until birth and have a wide range of effects, including:

a) Maintaining, controlling and stimulating the production of other pregnancy hormones
b) Needed for correct development of many foetal organs including the lungs, liver and kidneys
c) Stimulating the growth and correct function of the placenta
d) Promoting growth of maternal breast tissue (along with progesterone) and preparing the mother for lactation (breastfeeding).

Other hormones produced by the placenta

The placenta also produces several other hormones including human placental lactogen andcorticotrophin-releasing hormone.  The function of human placental lactogen is not completely understood, although it is thought to promote the growth of the mammary glands in preparation for lactation.  It is also believed to help regulate the mother’s metabolism by increasing maternal blood levels of nutrients for use by the foetus. Corticotrophin-releasing hormone is thought to regulate the duration of pregnancy and foetal maturation.   For example, when pregnant women experience stress, particularly in the first trimester of pregnancy, the placenta increases the production of corticotrophin-releasing hormone.  There is a good reason for this: in the first days of pregnancy, corticotrophin-releasing hormone suppresses the mother’s immune system, preventing the mother’s body from attacking the foetus.  Later in pregnancy, it improves the blood flow between the placenta and foetus.  In the last weeks of pregnancy corticotrophin-releasing hormone levels climb even higher – a rise which coincides with a major spike in cortisol levels. The rise in corticotrophin-releasing hormone and cortisol may help the foetal organs mature just before labour begins, and influence the timing of birth, through production of a ‘late-term cortisol surge’.  This prenatal cortisol surge has also been linked to more attentive mothering in both animals and women, and is thought to be an adaptive response that induces an increased liking for their infant’s body odours, cementing the bond between mother and baby.

Side-effects of pregnancy hormones

High levels of progesterone and oestrogen are important for a healthy pregnancy but are often the cause of some common unwanted side-effects in the mother, especially as they act on the brain.  Until the mother’s body has adapted to the higher levels of these hormones, mood swings can be very common.  The majority of women will experience morning sickness – a feeling of nausea, any time of day, which may lead to vomiting.  The exact cause of morning sickness is unknown but it is likely to be because of the rapid increase in: oestrogen and progesterone; human chorionic gonadotrophin; or a closely related thyroid hormone called thyroid stimulating hormone which decreases during early pregnancy, although it is probably caused by a combination of all these hormonal changes.  Morning sickness usually starts around week 5-6 of pregnancy and should subside by week 12-16, although some women suffer throughout pregnancy.

Many women experience pain and discomfort in the pelvis and lower back during the first trimester.  This is mostly due to a hormone called relaxin.  Relaxin becomes detectable by week 7-10 and is produced throughout pregnancy.  This hormone relaxes the mother’s muscles, joints and ligaments to make room for the growing baby.  The effects of relaxin are most concentrated around the pelvic region; softening the joints of the pelvis can often lead to pain in the area.  The joints being softer can also decrease stability and some women may notice it is harder to balance.  There is also an increase in constipation associated with reduced gut motion because of the relaxin and the growth of the foetus. Although uncomfortable and frustrating at times, all these side-effects will usually lessen or even subside by the end of the first trimester.

Hormones and labour

The hormones of birth include estrogen and progesterone, oxytocin, beta-endorphins, prolactin and catecholamines (epinephrine/adrenaline and norepinephrine/noradrenaline). The exact events leading up to the onset of labour are still not fully understood.  For the baby to arrive, two things must happen: the muscles in the womb and abdominal wall have to contract and the cervix needs to soften, or ripen, allowing passage of the baby from the womb to the outside world.

Estrogen and progesterone are the main hormones involved in “setting the scene” for birth, including activating, inhibiting and reorganizing other hormone systems. They both play a crucial role in the initiation of labour. For example, the placental production of estriol increases by more than 1,000 times close to the onset of labor, and progesterone production increases 10-18 times higher. Estrogen has also been shown to increase the number of uterine oxytocin receptors and gap junctions in late pregnancy, which is thought to prepare the uterus for contractions in labour.

The hormone oxytocin plays a key role in labour.  Some recent studies have found that oxytocin produced by the fetus may directly stimulate the mother’s uterine muscle, suggesting that the baby may be responsible for initiating labour.Often called the ‘love hormone’, oxytocin is associated with feelings of bonding and motherhood.  This is also true of another hormone released during labour called prolactin.  If labour needs to be induced, oxytocin or a synthetic oxytocin equivalent is often administered to ‘kick-start’ the process.  Oxytocin levels rise at the onset of labour, causing regular contractions of the womb and abdominal muscles.  Oxytocin induced contractions become stronger and more frequentwithout the influence of progesterone and oestrogen, which at high levels prevent labour.

The cervix must dilate to 10cm for the baby to pass through.  Oxytocin, along with other hormones, stimulates ripening of the cervix leading to successive dilation during labour.  Oxytocin, with the help of the high levels of oestrogen, causes the release of a group of hormones, known as prostaglandins, which may play a role in ripening of the cervix.  Levels of relaxin also increase rapidly during labour.  This aids the lengthening and softening of the cervix and the softening and expansion of the mother’s lower pelvic region, thereby further aiding the baby’s arrival.

As labour contractions become more intense, natural pain relief hormones are released.  Known as beta-endorphins, they are similar to drugs like morphine and act on the same receptors in the brain.  As well as pain relief, they can also induce feelings elation and happiness in the mother.  As birth becomes imminent, the mother’s body releases large amounts of adrenaline and noradrenaline – so-called ‘fight or flight’ hormones.  A sudden rush of these hormones just before birth causes a surge of energy in the mother and several very strong contractions which help to deliver the baby.

Hormones after labour

When the baby is born, oxytocin continues to contract the womb in order to restrict blood flow to the womb and reduce the risk of bleeding and to help detach the placenta which is delivered shortly afterwards.  Blood levels of oxytocin and prolactin are very high, which supports bonding between the mother and baby.  Skin-to-skin and eye contact between the mother and baby also stimulate the release of oxytocin and prolactin, further encouraging bonding.  Many mothers describe being in a euphoric state just after labour; this is due to the effects of oxytocin, prolactin and beta-endorphins.

Women are actually able to breastfeed at around four months of pregnancy but high levels of progesterone and oestrogen during this time prevent lactation.  After the placenta is delivered during birth, the blood levels of progesterone and oestrogen fall, allowing the mother to produce the first meal of colostrum, a high density milk that contains more protein, minerals and fat-soluble vitamins (A and K) than mature milk, which is eminently suitable for the newborn.  When the baby suckles, oxytocin and prolactin are released from the pituitary, and pass through the mother’s blood to the breast, where prolactin stimulates milk production and oxytocin stimulates milk delivery to the nipple.  As well as stimulating bonding, these hormones also aid milk release and further milk production.  Mature milk that nourishes the baby and induces sleep starts to be produced about four days after birth.The period about two to three days after the birth when the mother may feel tearful and upset is often referred to as the ‘baby blues’, and can be explained in part by the action of hormones. There are a number of factors which contribute to this, and the falling levels of most of the hormones described are probably a major cause. Usually the feelings disappear after a day or two. More serious and prolonged feelings of sadness or helplessness may develop into postnatal depression and mothers (or fathers who also experience this) will need professional help.


Society for Endocrinology. You & Your Hormones is the official public information website of the Society for Endocrinology


Homebirth Is Safe

Birth is meant to be left alone. To interrupt the birth process, to disturb and disrupt it….forever changes it.  Home delivery should be an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved. Homebirth midwives provide one-to-one midwife care and they have good resuscitation skills and live in a location that allows quick access to obstetric care. Homebirth is safe. In some regards it is actually safer than a hospital birth. One of the problems with this question is that in asking it, there is a hidden assumption that non-homebirths are the safety standard. I need to point out that no study has ever shown hospital births to be safer than homebirth. There’s risk in every pregnancy and every birth; it’s not possible to entirely eliminate risk by being in a hospital. It is possible to minimize intervention by staying out of hospitals, though.

There are some benefits to doing the deed at home:

1) Giving birth at home can be less expensive than giving birth in a hospital.

2) Getting to the hospital while in labour can be painful/uncomfortable or very difficult.

3) Giving birth at home can give mom more control over what happens.

Here are some studies you can look up for more information A growing body of evidence demonstrates that, for low-risk women, home birth is at least as safe as hospital birth (Gyte & Dodwell, 2008). Risk is involved wherever birth takes place; somewhat different risks accrue in different settings. The question is whether, on balance, hospital birth is safer than home birth for low-risk women

The first, a nationwide cohort study of over half a million births in the Netherlands, concluded that “planned home birth in a low-risk population was not associated with higher perinatal mortality rates or an increased risk of admission to a NICU compared with planned hospital births” (de Jonge et al., 2009, p. 1181). The authors noted that the safety of home birth is enhanced by good referral and transportation systems, which facilitate transfer when needed.

The second study used data from the province of British Columbia on planned home births attended by registered midwives, and planned hospital births meeting the eligibility requirements for home births and attended by the same cohort of midwives and a matched sample of physician-attended planned hospital births (Janssen et al., 2009). The researchers likewise found that “planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.”

Hospitals carry their own set of risks that aren’t ever mentioned in studies. Unfortunately, babies die and moms die there too. There are just not big articles about it because the big money is behind the hospitals. It is absolutely true that caesarian section rates and unnecessary interventions are way higher at hospitals. Hospitals CAUSE many complications then take the credit for “saving” the situation.

Here are some studies people can look up for more information.

  • Articles About Homebirth allows you to purchase digital copies of certain magazines and journals.  By searching for homebirth safety you will have access to many studies you can read instantly.

  • The Cochrane Collaboration is the ultimate in evidence based research.  This review of the research found no strong evidence of either homebirth or hospital birth being safer than the other.  You can see all their recommendations for pregnancy and childbirth here.

  • The Midwives Alliance of North America maintains an extensive list of research about homebirth.  You may be able to access some of the journals listed through your local library, or by getting a library card at a nearby university library.

  • Citizens for Midwifery maintains a list of resources regarding midwifery issues.  Scrolling through this list will reveal several homebirth safety studies and fact sheets for you to use while educating yourself or others.

  • The Homebirth Reference Site maintains an index of homebirth research you can review.  You can view the references, or click on them to see the research.

  • Read the study in BMJ using hospital births from the 70s and 80s. You can read the entire text of the study here:

  • This is a small list of the many myths about homebirth,  like Bring Birth Home and My Best Birth’s “Advocacy & Research” resource list.

An excellent book is called “The Thinking Women’s Guide to a Better Birth.”  Those Henci is a powerful women and opinionated, her book shows volumes of evidence based research about birth. Despite this body of literature, there are still some physicians who persist in torturing the data in an attempt to frame their personal opinions as “science.”

Research-oriented blogs & websites:


De Jonge, A., Van der Goes, B. Y., Ravelli, A. C. J., Amelink-Verburg, M. P., Mol, B. W., Nijhuis, J. G, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. British Journal of Obstetrics and Gynaecology. 2009; 116 (9):1177–1184.

Janssen, P. A., Saxell, L, Page, L. A., Klein, M. C., Liston, R. M, Lee, S. K. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Canadian Medical Association Journal. 2009; 181(6–7):377–383.



My Home Birthkit

Home birth is intense and powerful. Women need to know they can birth at home People planning a home birth need to know that birth in a hospital is an odd new trend…birthing at home is the normal way to bring babies into the world. Women have been birthing babies in their “nests” since the beginning of time. Home birth is simple. It un-complicates a very natural process.

Midwives attending home births carry essential obstetric equipment to monitor the wellbeing of mother and baby and to deal with problems that may occur unexpectedly at birth. Essential equipment for home births is fairly minimal, easily fitting into a couple of bags. Parents are often surprised how little is used for a normal birth and also how little mess there is. Discussing equipment with women and taking time to briefly explain the mechanism of birth and infant transition to extra-uterine life enables them to feel confident in their bodies, which in turn facilitates the process.

As a homebirth midwife, I need a few supplies. At around 36 weeks I will take a birth kit to the house and the contents are explained to the woman and her partner so there are no surprises on the day. it is of outmost importance that the parents should see the contents. Therefore, the contents of the emergency bag are presented just in case the baby needs resuscitation. Parents find it helpful to know that the baby will not immediately be pink or that it may not cry. It is essential to prepare women and their partners for the birth. The opportunity is also taken to educate parents and birth partners on how to deliver a baby in the unlikely event that it arrives before the midwives do. A midwife should explain to the family that the only essential equipment they will need is warm towels or a blanket to keep baby and mother warm until the midwife or the paramedics arrive.

Most of my home births produce little mess, which is easily contained with some good pre-planning. I tell the family that they need plastic sheeting to protect the carpet, bed, birth mat or mattress, sofa etc. Plastic table cloths work well and a fitted plastic mattress covers alway go well.

I ask Women to have

Any old sheets or linen. Prospective grandparents are a useful source.

Hot water bottle to put on back or front of Mum in labour and to put on tummy afterwards for afterpains.

Nourishing, easily digested snacks of choice, yoghourts, Jordan bars, sugary sweets, dextrose tablets, bananas, Honey, crisps etc.

Nourishing fluids of choice

A nice soft big old towel to cover mum and baby together after the birth.

Sanitary Pads

A small soft towel to wrap baby in if necessary

Practically all the births I attended  at home, I have found a good waterproof protection for the floor, sofa, bed or wherever we end up, is a couple of metres of that waterproof table cloth that can be bought by the metre at good hardware or kitchen shops. It has a cloth backing and used cloth side up it is comfortable to walk on  it, and the midwife does not slide around all over the place.

The birth bag contains

• Five incontinence pads

• A surgical delivery pack

• IV’s for mom if she becomes dehydrated or addiitional nutrients

• Lots of sterile gloves

• Foetoscopes or ultrasonic stethoscopes

• Medications to slow or stop a haemorrhage

• Special herbal preparations, homeopathic remedies, massage supplies/techniques and even acupuncture needles

• Items for suturing tears

• A surgical delivery pack

• An in/out catheter (which is rarely used).

• Oxygen for the baby if needed

• IV’s for mom if she becomes dehydrated or needs additional nutrients

• Bloodpressure monitor

• Cylinders of Entenox, mouth pieaces and mask

• One Cylinder of Oxygen

• Pethidine and Narcan

• Suturing materials and local anaesthetics

Emergency Bag Contents

An emergency bag contains:

• A neonatal bag and mask

• A laryngoscope

• Extra syringes


Drugs are Syntocinon, Syntometrine and Ergometrine, Pethidine and Narcan, Vitamin K

The practice’s sterile delivery pack contains a plastic cord clamp, a pair of episiotomy scissors, two cord clamps and a pair of cord scissors.

• 1 large Ziplock bag (for placenta)

• 2 large garbage bags (for general clean-up)

• 6 packets of EmergenC vitimin drink

Old sheets for covering floors & carpets

You don’t need to have a fancy house or apartment. You don’t need to have a clean house. There will be blood, there will be fluids but midwives know what they’re doing and know how to clean up after them.

Other Handy Items…

• camera with extra film and/or EMPTY flash/memory card

• video Recorder

• tape Recorder

• phone list

• note pad and/or diary

Birth is NOT gory, or traumatic! It is a natural thing to happen, women are built to give birth and to allow the process to happen the way nature intends is the only way to go. Women always have the right to change their minds. If a woman decide in labour that she would prefer to go to hospital, that is always an option. As midwife I always carried nitrous oxide/entenox (laughing gas) to a home birth, which is a very effective form of pain relief for many women. Otherwise, I was allowed to give opiods at home in my country.

I am trained to provide emergency treatment if there are complications after the birth. Just like most other midwives, I do carry oxygen and resuscitation equipment for babies who are slow to breathe as well as intravenous fluids and drugs to treat heavy bleeding after birth. I have sutured many tears or episiotomies. Twice I had to transfer to hospital because of meconium stained liquor.

Delayed cord clamping/cutting

Delayed cord clamping means to delay the surgical intervention of clamping  the umbilical cord at birth. Early clamping and cutting of the umbilical cord is widely practised as part of the management of labour, but recent studies suggest that it may be harmful to the baby. At birth, he says, the umbilical cord sends oxygen-rich blood to the lungs until breathing establishes. So as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21% of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth. Author Tina Cassidy in her book Birth: The Surprising History of How We Are Born sheds some light on the subject:

“Throughout history, the immediate postpartum period has been as much a victim of fashion and misconception as has labor and birth.  And standard practice still varies among countries, hospitals, doctors, and midwives.  The first act that usually occurs after the slippery baby emerges is the cutting of the umbilical cord.  …The act also forces the newborn to breathe air through its lungs for the first time.  Perhaps because of the symbolism of that moment, cord cutting has been a magnet for drama, ceremony, and superstition.

In most hospitals today, cutting the cord is such an uneventful routine that it can pass unnoticed by the overwhelmed mother.  Doctors generally wait about thirty seconds a time period long enough, they believe, for the baby to receive all the blood it needs from the placenta.  …They then apply two clamps, break out the scissors, and often ask the father if he wants to cut between the ligatures.  Doing all of this quickly also allows for the baby to be suctioned, weighed, and swaddled, before it gets cold.

Some childbirth experts argue that, rather than being guided by a clock, it’s best to wait until the cord stops pulsing before cutting, allowing the baby to receive all the blood it was meant to receive from the placenta.  They say it helps the mother as well, because the placenta shrinks as it pumps out extra blood, making it easier to deliver.”

The research that SUPPORTS delayed cord clamping/cutting:

Delayed Umbilical Cord Clamping Boosts Iron In Infants (2006): A report of a study conducted by UC Davis nutrition professor Kathryn Dewey that revealed a two-minute delay in cord clamping at birth significantly increases a child’s iron status at 6 months of age.  This study documented for the first time that the beneficial effects of delayed cord clamping last beyond the age of 3 months.

Early versus delayed umbilical cord clamping in preterm infants (2004): A Cochrane review (considered the “gold standard” of research and evidenced based practice) of studies on babies born prematurely which revealed that delaying cord clamping for greater than 30 to 120 seconds, rather than early clamping as is the current obstetrical practice, seems to be associated with less need for transfusion, less intraventricular haemorrhage, and helped the babies adjust to their new surroundings better.

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (2008): A Cochrane review that showed no significant difference in postpartum hemorrhage rates when early and late cord clamping were compared. The review also reported growing evidence that delayed cord clamping confers improved iron status in infants up to six months after birth, with a possible additional risk of jaundice that requires phototherapy.  (It is important to note however that the act of placing the baby on the mother’s abdomen skin-to-skin above the level of the placenta assures that blood will continue to flow, but not to excess.)

The PROS of Delayed Cord Clamping/Cutting

Below is a summary of the literature regarding the pros and cons of immediate vs. delayed clamping of the cord.

1) The blood in the placenta rightfully belongs to the baby, and babies not receiving this blood have the deal with the equivalent of a major blood loss or hemorrhage at birth.  It is estimated that early clamping deprives the baby of 54 to 160 ml of blood, which represents up to half of a baby’s total blood volume at birth.

2) There is a significant amount of iron in the cord blood which the baby needs for optimal health and for the prevention of anemia.

3) Babies benefit from the increased oxygen available to them from the cord-blood when the taking these first few breathes.  The earlier the cord is clamped, the more likely the incidents of respiratory distress.

4) The blood that babies receives through the cord after birth acts as a source of nourishment that protects infants against the breakdown of body protein.

5) As an added bonus, delayed cord clamping keeps babies in their mother’s arms, the ideal place to regulate their temperature and initiate bonding and breastfeeding.

The CONS of Delayed Cord Clamping/Cutting 

1)     May increase the baby’s risk for jaundice, a condition that many newborns develop related to the baby’s immature liver that cannot process bilirubin, a yellow byproduct of the breakdown of old red blood cells.

It seemed to me that the PROS of delayed cord clamping outweigh the CONS however I feel that it is important to explore the subject of newborn jaundice more…that is, Is it something that parents should be worried about?  Is it serious enough to trump all of the research supported benefits of delayed cord clamping?

Berwald, M. (2009). Late vs Early Clamping of the Umbilical Cord in Newborn Babies. Birth Bliss. Retrieved from website:

Buckley, S. (2005). Leaving well alone: A natural approach to the third stage of labour.

Cassidy, T.  (2006). Birth: The Surprising History of How We Are Born. Atlantic Monthly Press.

Third Stage of Labour – Benefits of A Natural Approach

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 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 sequellae 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’.

Medical Management of the Third Stage

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 sequellae 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.

Your 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-Pituatary-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 in the perinatal period such as exposure to drugs, birth complications and separation or rejection from the mother.

A crucial role for birth attendants in these times is to ensure that a woman’s mammalian instincts are protected and valued during pregnancy, birth and afterwards. Ensuring unhurried and uninterrupted contact between mother and baby after birth, adjusting the temperature to accommodate a shivering mother, and to allow skin-to-skin contact and breastfeeding, and not removing the baby for any reason- these are practices that are sensible, intuitive and safe, and help to synchronise our hormonal systems with our genetic blueprint, giving maximum success and pleasure for both partners, in the critical function of child-rearing.

The baby, the cord, and active management

Adaptation to life outside the womb is the major physiological task for the baby in third stage. In utero, the wondrous placenta fulfills the functions of lungs, kidney, gut and liver for our babies. Blood flow to these organs is minimal until the baby takes a first breath, at which time huge changes begin in the organisation of the circulatory system.

Within the baby’s body, blood becomes, over several minutes, diverted away from the umbilical cord and placenta and, as the lungs fill with air, blood is sucked into the pulmonary (lung) circulation. Mother Nature ensures a reservoir of blood in the cord and placenta, that provides the additional blood necessary for these newly-perfused pulmonary and organ systems.

The transfer of this reservoir of blood from the placenta to the baby happens in a step-wise progression, with blood entering the baby with each third-stage contraction, and some blood returning to the placenta between contractions. Crying slows the intake of blood, which is also controlled by constriction of the vessels within the cord (Gunther 1957) – both of which imply that the baby may be able to regulate the transfusion according to individual need.

Gravity will affect the transfer of blood, with optimal transfer occurring when the baby remains at or below the level of the uterus until the cessation of cord pulsation signals that the transfer is complete. This process of “physiological clamping” typically takes 3 minutes, but may be longer, or can be complete in only one minute. (Linderkamp 1982)

This elegant and time-tested system, which ensures that an optimum, but not a standard, amount of blood is transferred, is rendered inoperable by the current practice of early clamping of the cord- usually within 30 seconds of birth.

Early clamping has been widely adopted in Western obstetrics as part of the package known as active management of the third stage. This comprises the use of an oxytocic agent – a drug that, like oxytocin, causes the uterus to contract strongly – given usually by injection into the mothers thigh as the baby is born, as well as early cord clamping, and ‘controlled cord traction’ – that is, pulling on the cord to deliver the placenta as quickly as possible.

Haste becomes necessary, because the oxytocic injection will, within a few minutes, cause very strong uterine contractions that can trap an undelivered placenta, making an operation and ‘manual removal’ necessary. Furthermore, if the cord is not clamped before the oxytocic effect commences, the baby is at risk of having too much blood suddenly pumped from the placenta by the over-zealous contractions.

While the aim of active management is to reduce the risk of haemorrhage for the mother, “its widespread acceptance was not preceded by studies evaluating the effects of depriving neonates [newborn babies] of a significant volume of blood” (Piscane 1996)

It is estimated that early clamping deprives the baby of 54 to 160 ml of blood, (Usher 1963) which represents up to half of a baby’s total blood volume at birth. “Clamping the cord before the infant’s first breath results in blood being sacrificed from other organs to establish pulmonary perfusion.[blood supply to the lungs].Fatality may result if the child is already hypovolemic [low in blood volume].” (Morley 1997)

Where the baby is lifted above the uterus before clamping – for example during caesarean surgery – blood will drain back to the placenta by gravity, making these babies especially liable to receive less than their expected blood volume. The consequence of this may be an increased risk of respiratory (breathing) distress- several studies have shown this condition, which is common in caesarean-born babies, to be eliminated when a full placental transfusion was allowed. (Peltonen 1981, Landau 1953).

The baby whose cord is clamped early also loses the iron contained within that blood – early clamping has been linked with an extra risk of anaemia in infancy. (Grajeda 1997,Michaelson 1995).

These sequellae of early clamping were recognised as far back as 1801, when Erasmus Darwin wrote: “Another thing very injurious to the child is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a part of the blood being left in the placenta which ought to have been in the child” (Darwin 1801).

In one study, premature babies experiencing delayed cord clamping – the delay was only 30 seconds – showed a reduced need for transfusion, less severe breathing problems, better oxygen levels, and indications of probable improved long-term outcomes, compared to those whose cords were clamped immediately. (Kinmond 1993).

Some studies have shown an increased risk of polycythemia (more red blood cells in the blood) and jaundice when the cord is clamped later. Polycythemia may be beneficial, in that more red cells means more oxygen being delivered to the tissues. The risk that polycythemia will cause the blood to become too thick (hyperviscosity syndrome), which is often used as an argument against delayed cord clamping, seems to be negligible in healthy babies. (Morley 1998)

Jaundice is almost certain when a baby gets his or her full quota of blood, and is caused by the breakdown of the normal excess of blood to produce bilirubin, the pigment that causes the yellow appearance of a jaundiced baby. There is, however, no evidence of adverse effects from this. (Morley 1998). One author has proposed that jaundice, which is present in almost all human infants to some extent, and which is often prolonged by breastfeeding, may actually be beneficial because of the anti-oxidant properties of bilirubin. (Gartner 1998)

Early cord clamping carries the further disadvantage of depriving the baby of the oxygen-rich placental blood that mother nature provides to tide the baby over until breathing is well established. In situations of extreme distress- for example, if the baby takes several minutes to breathe-this reservoir of oxygenated blood can be life saving, but, ironically, standard practice is to cut the cord immediately if resuscitation is needed.

The placental circulation acts, when the cord is intact, as a conduit for any drug given to the mother, whether during pregnancy, labour or third stage. Garrison (1999) reports that Narcan, which is sometimes needed by the baby to counteract the sedating effect of pain-relieving drugs such as pethidine (demorol), given to the mother in labour, can be effectively administered via the mother’s veins in third stage, waking up the newborn baby in a matter of seconds.

The recent discovery of the amazing properties of cord blood, in particular the stem cells contained within it, heightens, for me, the need to ensure that a newborn baby gets its full quota. These cells are unique to this stage of development, and will migrate to the baby’s bone morrow soon after birth, transforming themselves into various types of blood-making cells,

Cord blood harvesting, which is currently being promoted to fill Cord Blood Banks for future treatment of children with leukaemia, involves immediate clamping, and up to 100 ml of this extraordinary blood can be taken from the baby to whom it belongs. Perhaps this is justifiable where active management is practiced, and the blood would be otherwise discarded, but, unfortunately, cord blood donation is incompatible with a physiological (natural) third stage.

Active Management and the Mother

Active management (oxytocic, early clamping and controlled cord traction) represents a further development in third stage interference that began in the mid-seventeenth century, when male attendants began confining women to bed, and cord clamping was introduced to spare the bed linen.

Pulling on the cord was first recommended by Mauriceau in 1673, who feared that the uterus might close before the placenta was spontaneously delivered (Inch 1984). In fact, the recumbent (lying) postures, increasingly adopted under doctor’s care meant that spontaneous delivery of the placenta was less likely: the upright postures that women and midwives have traditionally used encourage the placenta to fall out with the help of gravity.

The first oxytocic to be used medically was egot, derived from a fungal infection of rye. Ergot was known to to be used by 17th and 18th century European midwives. Its use was limited, however, by its toxicity. It was refined and revived as ergometrine in the 1930’s, and by the late 1940’s, some doctors were using it as a preventatively, as well as therapeutically, for post partum haemorrhage. (Inch 1984) Potential side effects from ergot derivatives include a rise in blood pressure, nausea, vomiting, headache, palpitations, cerebral haemorrhage, cardiac arrest, convulsion and even death.

Synthetic oxytocin, which mimics the effects of natural oxytocin on the uterus, was first marketed in the 1950’s, and has largely replaced ergometrine, although a combination drug, called syntometrine, is still used, especially for severe haemorrhage. Syntocinon causes an increase in the strength of contractions, whereas ergometrine causes a large, ‘tonic’ contraction, which also increases the chance of trapping the placenta. Ergometrine also interferes with the process of placental separation, increasing the chance of partial separation. (Sorbe 1978)

Recently active management has been proclaimed “the routine management of choice for women expecting a single baby by vaginal delivery in a maternity hospital” (Prendville 1999), mostly because of the results of the recent Hinchingbrooke trial, comparing active versus “expectant” (physiological) management.

In this trial (Rogers 1998), which involved only women at low risk of bleeding, active management was associated with a post partum hemorrhage (blood loss greater than 500ml) rate of 6.8%, compared with 16.5% for expectant (non-active) management. Rates of severe PPH (loss > 1000ml) were low in both groups- 1.7% active and 2.6% expectant.

The authors note further that, from these figures ten women would need to receive active management to prevent one PPH. They add “Some women “¦ may rate a small personal risk of PPH of little importance compared with intervention in an otherwise straightforward labour, whereas others may wish to take all measures to reduce the risk of PPH.”

Reading this paper, one must wonder how it is that almost 1 in 6 women bled after “physiological” management, and whether one or more components of western obstetric practices might not be actually increasing the rate of haemorrhage.

Botha (1968) attended over 26,000 Bantu women over 10 years, and reports that “a retained placenta was seldom seen… blood transfusion for postpartum haemorrhage was never necessary.” Bantu women deliver both baby and placenta while squatting, and the cord is not attended to until the placenta delivers itself by gravity.

There is some evidence that the practice of clamping the cord, which is not practiced by indigenous cultures, contributes to both PPH and retained placenta by trapping extra blood (around 100ml, as described above) within the placenta. This increases placental bulk, which the uterus cannot contract efficiently against, and which is more difficult to expel. (Walsh 1968)

Other western practices that may contribute to PPH include the use of oxytocin for induction and augmentation (speeding up labour) (Brinsden 1978, McKenzie 1979), episiotomy or perineal trauma, forceps delivery, caesarean and previous caesarean (because of placental problems- see Hemminki 1996).

Gilbert (1987) notes that PPH rates in her UK hospital more than doubled from 5% in 1969-70 to 11% in 1983-5, and concludes “The changes in labour ward practice over the last 20 years have resulted in the re-emergence of PPH as a significant problem.” In particular, she links an increased risk of bleeding with induction using oxytocin, forceps delivery, long first and second stages (but not prolonged pushing) and the use of epidurals, which increase the chance of forceps and of a long second stage.

As noted, western practices do not facilitate the production of a mother’s own oxytocin, neither is attention paid to reducing adrenaline levels in the minutes after birth, both of which are physiologically likely to improve uterine contractions and therefore reduce haemorrhage.

Clamping the cord, especially at an early stage, may also cause the extra blood trapped within the placenta to be forced back through the placenta into the mothers blood supply with the third stage contractions. (Doolittle 1966, Lapido 1971) This “feto-maternal transfusion” increases the chance of future blood group incompatibility problems, which occur when the current baby’s blood enters the mother’s blood stream, causing an immune reaction which can be reactivated and destroy the baby’s blood cells in a subsequent pregnancy, causing anaemia or even death.

The use of oxytocin, which strengthens contractions, either during labour, or in third stage, has also been linked to an increased risk of feto-maternal hemorrhage and blood group incompatibility problems. (Beer 1969, Weinstein 1971)

The World Health Organisation, in its 1996 publication Care in Normal Birth: a practical guide, argue that “In a healthy population (as is the case in most developed countries), postpartum blood loss up to 1000 ml may be considered as physiological and does not necessitate treatment other than oxytocics”. In relation to routine oxytocics and controlled cord traction, WHO cautions that “Recommendation of such a policy would imply that the benefits of such management would offset and even exceed the risks, including potentially rare but serious risks that might become manifest in the future”.

Choosing a Natural Third Stage

Choosing to forego preventative oxytocics, to clamp late (if at all), and to deliver the placenta by our own effort all require forethought, commitment, and that we choose birth attendants that are comfortable and experienced with these choices.

A natural third stage is more than this, however – we must ensure respect for the emotional and hormonal processes of both mother and baby, remembering how unique this time is. Michel Odent stresses the importance of not interrupting, even with words, and believes that ideally the new mother feels unobserved and uninhibited in the first encounter with her baby. (Odent 1992) This level of non-interference is uncommon, even in home and birth centre settings.

Third stage represents a first meeting, creating a powerful imprint upon the relationship between mother and baby. When both are undrugged and quiet, fully present and alert, new potentials are invoked, and we discover more about ourselves, and the sacred origins of our capacity to love.

Rachana. S. (2000).  Leaving the Umbilical Cord Intact. Lotus Birth. Greenwood Press, Yarra Glen

Buckley,  S.  (2005). Leaving Well Alone: A Natural Approach to the Third Stage of labour. Rerieved from website:

Sarah J Buckley is a NZ-trained GP, and an internationally-published writer and advocate for gentle choices in pregnancy, birth and parenting.