The placenta is an organ that your body grows for the baby to use. It grows on your uterus on the inside, and has a blood supply that is for the baby alone. The side that is to the mother is considered the meaty side, and the 'shiny' side is to the baby. This is where the baby lives for the 9 months. The placenta is commonly called the "after birth". This blood rich organ is about 9-11 inches across, and 1-2 inches thick. It sort of looks and feels like a piece of liver. Attached to the placenta inside is the umbilical cord, and the other end of course is attached to your baby. The placenta attaches itself to the inside of your uterus. This is where it is nourished from your body. It is very rich in blood. This means it has a lot of blood all around it and inside of it. The area where the cord is attached to the baby later becomes the belly button.
![[Placenta]](../images/Placenta_1.jpg)
![[Placenta]](../images/Placenta_2.jpg)
The placenta has many jobs. It sends oxygen to your baby, it sends nourishment to your baby. It removes waste products from your baby. It acts as a gland that produces hormones (these are what helps to cause mood swings in pregnancy). There are two arteries in the cord, and one vein. The vein is the largest one, and carries oxygen rich blood and nutrients to the baby. The other two are arteries and carry waste products from the baby to the placenta. The umbilical cord is filled with a jelly like stuff called whartons jelly. This helps to protect the blood vein and the arteries. When the baby is born , this stuff kind of swells which stops the exchange of blood. When that happens the cord has begun to stop pulsating . Once the cord has completely stopped pulsating, it is clamped and cut. To apply the clamp prior to this process will deprive your baby form blood rich oxygen that is still being sent from the placenta to the baby. When this process has stopped, then two clamps (a cord clamp and a instrument type of clamp) is applied and the cord is cut between the two. This cutting of the cord does not hurt the baby, as there are no attached nerves in the cord to the baby. Now the baby is no longer attached to the mother.
We have all heard of the bad births, the ones whose outcomes may not have been a good one. You may even have heard of some where they had a midwife. Once there is a 'bad birth', especially with a midwife, others will blame the care giver. If something goes wrong, it must be the doctors fault or the midwives fault. It is always easier to blame others than to take responsibility... why? because when you look at your little one you think, how could I be at fault for any choices that I made that may have brought harm to my infant, it must be the doctors or midwives fault.
We midwives, as care givers allow our clients to make decisions, as long as the baby and mother are doing well. Sometimes midwives allow labor to continue past what it might within a hospital, because it is what the client wants, even though we know that if you were in the hospital you would not have been allowed to continue this long in labor. (Remember this is when heart tones and vital signs remain with in the normal range.) Why? because you have the freedom to choose, and we never take that freedom away from you. Birth is not measured in hours with midwives as it is with the medical community. Midwives look for other signs as progress. What you as the client need to be aware and remember that although we will support you in your decision, you need to remain flexible in your choices. Birth has its own wisdom, sometimes that unwanted transfer will occur.
I encourage you to write your birth plan, to read all you can about every subject. You should never just allow someone to make the decisions for you. Your doctor or midwife is not GOD, they are care givers who are trained to assist you with the birth of your baby. Be informed with all aspects of birth, and take charge of your birth. Become empowered.
I do tell my clients that if you get really tired, then you need to go rest. I would rather that you rest on your left side while in labor. Sometimes this will help a slow labor to progress. If the mother is too tired, then resting gives her the energy to continue, and the labor usually picks up after a nap. Even a 20 minute nap helps.
Standing, walking or sitting are all good for the labor, allowing the use of gravity to work, and also is good for the oxygenation of the baby. It helps speed up a slow labor, and also makes the contractions more effective. It allows you to have a good pushing urge also. These positions may also help if you are having back labor, to reduce the pain of back labor. They help with the baby to become well aligned into the pelvis as it descends.
Kneeling, on hands and knees, or leaning forward all allow good working space for a postier baby to turn from posterior to anterior. Remember that a posterior baby will make a labor more painful in the back and a longer labor as the baby tries to find its way threw the pelvis. You can use the birth ball to help lean on, or a chair in front of you with pillows for support to lean onto.
Sitting on the birth ball or a toilet helps to relax the perineum. It uses gravity, and with the relaxation aids with the descent of the infant into the pelvis. The toilet is about the best, especially for a first time mother,. She has the understanding that to push her baby out means that she may also have some BM pushed out as she pushes. Most mothers are embarrassed by this, so to start pushing on the toilet will help a first time mother push better. If she has a small BM, then she knows that she is on the toilet and that is the correct spot in her mind, so she relaxes.
Semi sitting is more comfortable for the mother, does use gravity, but sometimes the tail bone is in the way with this position. If this happens, we have the mother either get up into a squat or lay on her side. That allows the tail bone to flex back out of the way.
Squatting is a way to shorten the birth canal length. It allows more room for the baby as it increases the diameter that the pelvis is open. Helps a mother to push down easier.
Side lying is good for the babys oxygenation if she is on her left side. Right side is not recommended due to the fetal blood circulation from the mothers body. This is a good way for mother to rest between contractions also. We will hold you leg up as you push.
Hands and knees is good for back labor, used easily with the birth ball, and takes pressure off of hemorrhoids. If your baby is posterior, it will aid in the turning of the infant. If you baby is large or has any problems with the delivery of the shoulders, you are sometimes asked to turn into this position once the head is born. Gaskin maneuver.
Water is wonderful for therapy for all kinds of problems. The medical community has been using water therapy for back injuries and other injuries as a form of therapy for years. Some physical therapy units have pools and hot tubs to be used for the therapy process.
Why not for birth? Many babies are now being born into water. Water therapy is wonderful for a hard labor or a long labor. It helps for back labor as well. If you are having a long labor, perhaps the baby is slightly posterior and needs to turn. Sometimes those contractions are so hard for mothers to deal with, and after they climb into the tub, they are able to relax more and that helps to turn the baby as they relax. Most all mothers like the water therapy. If you don't want to deliver in the water, at least labor in the water.
The following photos are of one of my grand child's birth. After being in the tub, many mothers find their labor shortened. It is safe to deliver in the tub. Remember that babies do not breathe until they take a breath of air. As long as they are under the water, their body will function just like they were in side of the uterus, in the bag of waters. For a baby that has mech. stained fluid, it is s great way to reduce the chance of aspiration. (when the baby has a bowel movement prior to the birth, this sticky stool can be aspirated into the lungs even before birth -Remember that this does NOT guarantee that a baby will NOT aspirate meconium, as they can do this while in the uterus too.) The bath water washes out the baby's mouth and removes the mech. from the infant's mouth. We still may suction the baby when we bring him/her up onto mom's chest.
![[Water birth photo]](http://www.birthgreeter.com/images/water1.jpg)
![[Water birth photo 2]](http://www.birthgreeter.com/images/nbtrt.jpg)
What do you want in labor? What kind of interventions will you allow? Would you allow a enema or shaving prep? Do you want to be allowed to eat and drink what you want? Do you want to move around and change positions as you want? Do you want your midwife to suggest positions that may help your labor? Do you prefer to keep the vaginal exams to a minimum?
Augmentation/induction Do you want your labor started if you go over due? Will you want your amniotic membranes ruptured artificially to start labor or during labor to get it going 'faster'? Will you want to use natural ways first? Such as nipple stimulation.
