“A safe and effective physiological placental birth requires effective endogenous oxytocin release. This is generally facilitated by:
■ A physiological birth of the baby: No interventions during the birth process eg. induction, augmentation, epidural, medication, instructions or complications.
■ An environment that supports oxytocin release: Privacy, low lighting, warmth and comfort. No strangers entering the birth space eg. paed or extra midwife.
■ Undisturbed contact between mother and baby: others must not handle the baby or engage the mother in conversation (no hatting, no chatting and no hatting – Carla Hartley).
■ No fiddling: No feeling the fundus. No clamping, cutting or pulling on the umbilical cord. No clinical observations or ‘busying’ around the room.
■ No stress and fear: Those in the room must be relaxed. The midwife needs to be comfortable with waiting and have patience. The mother must not be stressed as adrenaline inhibits oxytocin release. This is why a PPH often occurs after a complicated birth (eg. shoulder dystocia) and when the baby needs resuscitating.
■ No prescribed timeframes: Many hospital policies require intervention within half an hour if the placenta has not birthed. This is not helpful and generates anxiety which is counter productive.”