Today we’re breaking down the nuances of the third stage of labor. I sat down with Miri Halliday, a certified professional midwife and owner of Spokane River Birth Center in Washington. We get into the many facets of the third stage of labor, from the delivery of the placenta to commonly debated interventions like Pitocin and cord traction. Miri demystifies these conversations, shedding light on their pros, cons, and the nuances that make each birth unique. Drawing from her extensive experience in both the UK and the US, Miri shares invaluable insights that can help parents prepare for this final stage of labor. Whether you're preparing for your own birth or just curious about what happens after the baby arrives, this episode is packed with practical advice and thoughtful discussion around the third stage of labor.

Helpful Timestamps:

• 00:20 Meet Miri: A Certified Professional Midwife
• 08:37 The Third Stage of Labor
• 20:25 Pitocin Use and Postpartum Depression
• 26:28 Pitocin in Hemorrhage Management
• 26:54 Pitocin in Different Stages of Labor
• 28:19 Personal Birth Experience with Pitocin
• 30:03 Cord Traction in Placenta Delivery
• 31:27 Gentle Cord Traction vs. Aggressive Pulling
• 36:56 Provider Trust and Birth Nuances
• 43:48 Social Media and Birth Information
• 48:19 The Importance of a Supportive Birth Team

More from Miri Halliday:

• Follow her on Instagram: @miri_the_birth_nerd

About your host:

Lo Mansfield, MSN, RNC-OB, CLC is a registered nurse, mama of 4, and a birth, baby, and motherhood enthusiast. She is both the host of the Lo & Behold podcast and the founder of The Labor Mama.

For more education, support and “me too” from Lo, please visit her

website and check out her online courses and digital guides for birth, breastfeeding, and postpartum/newborns. You can also follow @thelabormama and @loandbehold_thepodcast on Instagram and join her email list here.

For more pregnancy, birth, postpartum and motherhood conversation each week, be sure to subscribe to The Lo & Behold podcast on Apple Podcasts, Spotify, or wherever you prefer to listen!

A request: If this episode meant something to you, would you consider a 5 star rating and leaving us a review? Yes, we read them, and yes, they help keep L & B going! ♥️

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Disclaimer

Opinions shared by guests of this show are their own, and do not always reflect those of The Labor Mama platform. Additionally, the information you hear on this podcast or that you receive via any linked resources should not be considered medical advice. Please see our full disclaimer here.

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Produced and Edited by Vaden Podcast Services

Motherhood is all consuming.

Having babies, nursing, feeling the fear of loving someone that much, and there's this baby on your chest, and boom, your entire life has changed.

It's a privilege of being your child's safest space and watching your heart walk around outside of your body.

The truth is.

I can be having the best time being a mom one minute, and then the next, I'm questioning all my life choices.

I'm Lo Mansfield, your host of the Lo and Behold podcast, mama of four Littles, former labor and postpartum RN, CLC, and your new best friend in the messy middle space of all the choices you are making in pregnancy, birth, and motherhood.

If there is one thing I know after years of delivering babies at the bedside and then having, and now raising those four of my own, it is that there is no such thing as a best way to do any of this.

And we're leaning into that truth here with the mix of real life and what the textbook says, expert Insights and practical applications.

Each week we're making our way towards stories that we participate in, stories that we are honest about, and stories that are ours.

This is the lo and behold podcast.

I have to view props first for being here because I feel like some people read the episode title and they thought, I am not interested in listening to a conversation about the placenta in the third stage of labor.

So good job.

I want you to listen to this conversation because it is important and is valuable.

And there is some nuance here that I really want you to carry forward into whatever birth might be in front of you.

So my guest today is Miri.

She's a certified professional midwife.

I'll let her introduce herself more as soon as we get going, but I basically saw a reel of hers.

She was addressing the third stage of labor.

I loved the way she was approaching it, the way she was educating about it.

And I just instantly sent her a message and said, will you please come on?

And can we chat about this in just kind of like honest blunt.

Very, yeah, nuanced again, but that nuanced way that I think this conversation deserves.

And I think it's valuable because all of you are going to get ready to have the baby.

Have the baby, and then what happens next.

And there's a lot that happens next.

And I don't want you guys to forget about this stage of your labor.

So that's what Mary and I are chatting about.

I think you will find that you're gonna walk away and actually go, huh, that was so valuable.

And she had.

So much to tell me that I can now carry into either, you know, my prenatal conversations or my actual upcoming delivery.

So let's get into this combo that I had with Mary.

Mary, I am so glad to have you with me today.

Why don't you kind of go ahead and introduce yourself, tell us what you want us to know about what you do, why you do it, and then we'll just get into the conversation from there.

Yeah, my name's Mary Halladay.

I'm a midwife, licensed in Idaho and Washington, and a certified professional midwife.

I own a birth center and, so kind of a busy practice in Washington, Spokane.

I also run the account, Mary, the birth nerd, which is my little side passion.

And it's mainly just me.

Kind of having a good time and being creative with reels.

And I kind of started into midwifery because I grew up in the uk and midwifery is the model of care over there, that's the norm.

So you would never see an obstetrician unless there was something not normal with your pregnancy.

And so midwifery care is kind of the default.

And I just saw my mom have.

Great births and I'm one of five kiddos.

I saw my younger brothers being born.

So it, it always was kind of a passion of mine that when I was little, I kind of looked up to these midwives and thought that's kind of what I wanna do one day.

Immigrating to the USA when I was 15 with an idea that I was gonna become a midwife was like.

Maybe this isn't gonna be the path anymore because it seemed like it was a lot more confusing.

And so eventually though I got back into it.

Got my bachelor's degree in midwifery and that's where I'm at now.

Okay.

I have.

Four things.

I hope I don't forget them all, just from your intro that are probably not relevant to everyone.

But I geographically didn't know all of this, so I am from Washington State, so just anytime someone shouts out the Pacific Northwest Yeah.

From the San Juan Islands, went to the University of Washington.

I didn't realize you were down there.

I mean most, most of you probably know that, but I'm assuming, do you actually work in both states?

You're right on the, are you close to the border and is that why you're kind of right there and you get people from.

Both sides.

Idaho, Idaho and Washington and Oregon.

Yeah.

I'm trying to think where you are.

No, I'm right on the border between, so the tip top of Idaho, Northeast Washington would be, yeah.

So, right?

Yeah.

Oh, you up at the top?

Top of Idaho.

Okay, got it.

Got it.

Yeah.

So Coeur d'Alene, Idaho is Yes.

Okay.

Like, close to me, like 30 minutes from Spokane.

Okay.

So I, I serve both areas, but because.

Just basically do birth center birth in Spokane.

I don't tend to cross into the Idaho side.

Okay.

Having my Idaho license is just kind of like.

Hey, if I did have a friend in Idaho who wanted to do a home birth or something, I would do that.

But primarily I'm in Washington.

Okay.

And then I do have people that come over into, Spokane to have their babies at the birth center from Idaho, because they are, we are one of the only providers in the area that take Idaho Medicaid.

Okay.

So that's a big

deal for a lot of people.

Yeah, definitely.

Okay.

Geography thing number two.

I got to live in the Netherlands for two years, and came back pregnant with our fourth.

And so I know you just mentioned growing up the UK and the midwifery care over there and it was really, it was really cool to be a part of their OB care for the first half of my pregnancy and just see how different it is and kind of what the defaults are there.

'cause they are a little bit different than here in the us.

Maybe that'll come up in our convo about the third stage of labor when we get into it too.

But I just think that that's cool that you can kind of bring that into, because I know for myself, when I, when I look at some research and I'm like, I'll, I don't have my PhD.

It's not like I'm in here analyzing research every day as a job or a career.

But I do love to see like, Hey, what are they doing in the uk?

What are they doing in these other countries?

What are their standards of practice?

And then pull that into decision making for us, not only looking at what our ACOG does or you know, a governing body like that.

I just think it's.

Really helpful sometimes when you're making a choice and it feels, hey, this is kind of ambiguous.

And then we can look outside of the US and see what our other country's doing and what do they feel like is safe and appropriate and all that too.

So, no question there, but I just like having that, that,

that influence and that input, I think is, I'm assuming is also valuable for you.

I know you've been here for a while now in the us but I think it's cool to be able to hold both in, especially in this birth world for sure.

Okay.

The other question, you said you saw your two brothers be born, was that home birth or was that birth center or hospital and you were involved?

Where did those happen?

So,

yeah, I really misspoke 'cause I forget I have a little sister.

Okay.

I don't, maybe you did say too, but I dunno what you said now.

I think I did.

But I ha have been at one of my younger brother's births and.

My other brother was actually born in the hospital.

I wasn't at that birth.

Okay.

Typical kid came in after the delivery and everything, you know?

Yeah.

Yeah.

So, so got to see him in the hospital, but I was actually present for one of my younger brothers and then Okay.

My younger sister also a home birth, so.

Okay.

So two births when I was, you know, in a very, in a time of my life, you know why?

You're very impressionable by everything.

Mm-hmm.

And so my youngest sister was born and there's a big age gap between us.

So my youngest sister was born when I was 14.

Okay.

So, or 13.

Yeah, 13.

And so that was like.

Seeing how the midwives were and actually didn't like the midwife originally.

I remember thinking she was a bit bossy and I didn't really like that she wasn't as soft spoken and sweet as the midwife would had previously.

Okay.

But we actually ended up loving her.

She was exactly who my mom needed.

'cause my mom actually had a bit of like a hemorrhage after that birth.

Okay.

So, but she was amazing and I just remember looking up to them so much and thinking this is something that is amazing and I wanna do one day.

It's very cool.

My, the first birth I saw, I was a child too.

I think I was like eight or nine, and it wasn't really us.

It was by dad's nephew and they were pretty close to my mom and dad and they had a baby at home and so they called my mom.

My dad kind of was there with his nephew, called my mom, and so we were kind of brought over my sisters and I.

But she was having home birth in her tiny little house in our little town.

I remember the bathtub blown up or the big tub blown up in their Yeah.

Living room and, and looking back at it now, home birth was not common.

Like to me, I'm just a kid, right?

This is this lady having a baby.

I'd never seen any other, births and did not again for a very long time, probably until nursing school.

But it's funny to me to look back now and think like my first relationship with birth.

Was a home birth, like this little quiet home birth.

And I just remember flashes of it.

'cause I was young again, eight or nine or something.

And it, I remember it being dark.

I remember that pool.

I remember her making noises, like things like that.

Yeah.

And I don't know that that like shaped me.

I don't know that I would give it that, but it is kind of cool to think back of.

Yeah.

As a child, those are formative things that kind of do stick with you, however much you are or aren't involved.

So I think it's, it's not surprising.

Yeah.

That you got participated in that with your sibs and your mom and then here you are today.

Okay.

So I mentioned a little bit a second ago that I wanted to talk to you a little bit about the third stage of labor, which kind of can sound like wah wah.

Why are we gonna have a conversation about this?

But I think it's a very important piece of having our babies, right?

'cause we do all this work to get to the point where we have them.

Technically, clinically, that's like in the second stage you're pushing, they're born.

And then we get to this third stage, which is this placenta delivery and this kind of management choices, if you will.

And I'll just tell you guys the reason I like reached out to Mary after seeing one of her reels about.

The third stage of labor.

And you remember she kind of mentioned she likes to make like kind of funny reels.

I told her before we started kind of blunt or honest reels of like, Hey you guys, here's, here's just like the truth of X, Y, Z. And so she did this reel about the placenta and delivering the placenta and all of that.

And so I instantly was like, Hey, please come on the podcast.

I wanna talk to you about this.

'cause I loved the approach.

So I know we talked about this a little bit before we started, but.

If you could kind of just, how do you approach delivering information to all of us online and what that looks like for you?

And like I said, like I feel like hit your blunt, direct, honest, very intentionally.

So, so what's kind of that goal for you?

And then we can actually talk about this real and everything that I wanna go talk about after that.

Yeah.

So.

I kind of got into birth work as a doula first.

Okay.

And, part of my job as a doula was a lot of parent education.

Mm-hmm.

And so.

Very quickly and early on I realized that parents were being bombarded with a lot of information, from social media, TikTok, Instagram, you know, TikTok wasn't a thing then, but now, you know, there's a lot more, more even now.

And I just saw parents struggling so much, whether that was like a.

Birth story from one of their friends.

Unsolicited advice from in-laws, you know, whatever it was.

Parents were just sitting there with a great amount of confusion and a lot of biases that were just really out there, that were either or, based on someone else's individual experience.

And I think birth is such an individual experience.

That when you go crowdsourcing for information from a bunch of other moms, or I think there's wisdom in stories, but mm-hmm.

It can become very overwhelming.

Yeah.

And so with my content, I didn't wanna be someone that put something out there just because it was clickbait essentially.

Right.

Sometimes my original reel looks, click baby.

But then if you read Yeah, my educational points there, it's never that.

Mm-hmm.

So I wanted to make sure that the education that I was giving was gonna be as unbiased as possible.

And I think that that is just morally important to me.

Mm-hmm.

That I don't add to the noise to parents.

And sometimes.

Parents almost.

I've had negative feedback on that before where parents have been like, but what would you do like Miri Uhhuh, what would you do?

And it's like, I won't say it because it's, it's got nothing to do with me.

And how I make decisions for my birth and my baby are completely different to how someone else is gonna make decisions.

Yeah.

And you also have to look at that individual person's risk factors.

Their health history.

There's so much that goes into a decision about interventions and stuff that.

There's no way that I could tell someone on social media, you for sure should do this.

Right.

Generally with those types of decisions during childbirth, it's gonna be a lot of gray area and you're just sorting through, like you said.

I don't have a PhD in evidence, like looking at evidence either.

I look through the studies, I look at the recommendations that we have.

And I just present it as kind of unbiasedly as I possibly can.

I definitely talk about my own experience as a midwife and my own clinical experience.

Right.

But I try to lessen the fear and the noise of all of the.

Recommendations from experts on social media.

Right,

right.

It's funny, you also, you just said like on social media, I would never tell someone what to do, and I'm gonna guess that that's actually even true with your own clients that you see every day.

Like again, the job is not.

To tell you what to do.

The job is to say, here are the things that we know to be true, or the evidence has shown us X, Y, Z.

And then here's some of my anecdotal stories as well.

Like they all have value, like you said, but then the job is to say, what would you like to do with what we've just chatted about and how you feel and your intuitions and all of that.

And so I think it's kind of funny where people almost translate or expect social media to tell them what to do.

I'm like, that's like the last place that should be telling us what to do and really are.

Provider client relationships should not be telling us what to do either.

Like we should be deciding what to do, finding the people to help us decide Yeah.

But not make the decision for us.

So I love the way that you approach it.

And you mentioned as well, yes.

Some of my reals, like they might like look, click Beatty or whatever, you know.

I guess that's like to hook someone, so someone could say that is clickbait, but the education that follows in is like, Hey, no, here's what we're doing.

We're breaking down almost the opposite, right?

Someone's trying to go viral, someone's trying to be clickbait.

I'm gonna try to like hook you back and say, whoa, whoa, whoa.

Here's the truth.

And so I'm gonna actually read what was on.

The reel that I loved that you had initially posted.

And then we can kind of get into that conversation again, guys.

I wanted to talk about the third stage of labor with her, which is that placenta delivery time.

so that's what this reel is about.

So it was a reel of her.

Using a model, maybe your husband, because people commented about his teeth and she is like, we could maybe include the link in the show notes if you wanna see your hus or not.

His teeth.

I'm sorry.

Just feet.

His feet like this.

Teeth like

man's feet too.

It's not

even.

A question.

No, it's so funny, and I love that people were like, yeah, whose feet are those?

Anyways, on the reel it just says she doesn't know it yet, but I'm about to pull on her cord and nothing bad is going to happen.

And yes, someone is gonna read that maybe actually and get their hackles up, but the whole point is please read this caption, because what has happened with so much of.

Placenta delivery is all of this.

Like, don't let them do this.

Don't let them do this, or do do this, or you're gonna hemorrhage and bleed out.

Like there's all of this conversation about how to make decisions in your third stage of labor and how your birth attendant or provider.

If they do X, Y, Z, then it's gonna lead to X, Y, Z.

So you absolutely can't do X, Y, Z. And so to me, I just saw you going, Hey guys, please read this.

Like, here's why some things have value, some don't.

When they have value, when they don't, et cetera.

So why don't we start with just, why don't you kind of just lay out.

Kind of the different choices we do have in the third stage of labor or what we're talking about here and what you were kind of getting at in this reel of, Hey, here's some choices, some things going on in the third stage, both physiologically and then like what we're doing as parents making choices too.

Yeah.

I think that, I love that we're talking about it because I think a lot of parents don't think about it beyond.

Having the baby.

Right.

And then everything that comes afterwards can sometimes completely throw them off guard.

Mm-hmm.

Or they hear all these horror stories about fun massage or whatever, and they're like freaked out by it.

Right.

So I think it's a really good topic to talk about and it's one of my favorite actually, topics to talk about.

It's kind of funny, but I like it.

Yeah.

So the placenta.

You know, after the baby is born, eventually it has to come out.

Contractions continue.

Oxytocin should be high.

That love hormone that causes those contractions, that should be squeezing that uterus and then that.

The lack of a baby inside and the fact that your, your contractions is still going help to release that placenta out and then those contractions should continue.

'cause now you have this wound in your uterus that has open blood vessels.

And so we need the uterus to contract, to clamp down on those open blood vessels to prevent hemorrhaging or excessive bleeding.

And so.

Typically placenta come out pretty quickly after the baby is born.

You know, 10, 15 minutes.

Sometimes people don't adhere to that at all.

I don't know why some people just hang onto their placenta longer.

But eventually those contractions will bring that placenta out.

So the third stage is that process of after the baby comes out.

Then that whole delivery of the placenta, the options in it are that we can use things that help the uterus to contract more strongly.

So Pitocin, that artificial oxytocin, and that can go in as like a shot, intramuscularly or it can go in an IV if you already have one.

Typically in the hospital.

It's in a bag in the iv.

And it's kind of routinely done, I would say at most hospitals.

I've noticed a trend in my hospital lately, they've been asking before they do it, which is kind of nice.

Mm-hmm.

But typically historically it's been used routinely.

And the idea behind that is that, you know, the more oxytocin the better to really get that uterus to clamp down on those open blood vessels and prevent bleeding.

Kind of, yeah.

Active management versus expectant.

Mm-hmm.

We now kind of have the model because everyone is kind of believing in delayed cord clamping now that we have what's called kind of mixed management.

Right.

Whereas before we were doing, clamping the cord right away cutting the cord, and the doctor was immediately kind of bringing that placenta out through core traction and giving something to help the uterus contract.

What I would say is happening most of the time now is mixed management where mm-hmm.

Delay cord clamping is happening, and then we're typically still giving something to help contractions, Pitocin, and then there's some cord traction happening.

I've mm-hmm.

Rarely been at a hospital birth where there wasn't some core traction.

Then you have.

The physiological, you know, no kind of management of the third stage, which is just literally waiting for the kind of the urge to push out the placenta or upright gravity.

And we're relying on that oxytocin already high from the birth to prevent excessive bleeding and to continue to contract the uterus.

So those are kind of the three.

You got all the things.

Cord clamping immediately.

Mm-hmm.

Cord traction, Pitocin.

Then you've got kind of the middle road, which is, I would say, what's more common now in hospitals, and then you have more of what you would see.

I mean, absolutely people do it in hospitals, but I would say the third one is a lot more common.

More in a birth center or home birth setting.

Mm-hmm.

Mm-hmm.

And I would agree with you just from being at the bedside as well, mixed management is what I saw the most.

It felt like standardly that provider would like you to be getting the Pitocin after birth.

And then the rest kind of seemed more like, alright, let's give it some time, or I'll do your repair while we're waiting for the placenta.

But they did really want.

The Pitocin, that third stage Pitocin given.

Yeah.

What can you say about that?

Kinda the recommendations that do exist for, for giving that Pitocin, because I think, I know we specifically, were gonna kind of talk about chord traction in that as well, but that Pitocin becomes a pretty big.

Sticking point for some people of why would I need this?

Like you did just mention, we get this surge of oxytocin when our babies are born.

Like why do we need extra?

Where's, where's that coming from?

It's individual.

You can talk about that as well.

But yeah.

Where does all of that come from?

That part of the kind of argument or discussion?

Yeah.

We have some studies and anything with birth, I'm like.

It's hard to extract an absolute from studies when it comes to birth.

'cause birth is so unique.

Mm-hmm.

So we gotta think about the provider's attitude towards birth.

We have to think about the setting and most of the studies that were done were in the setting of high intervention hospitals.

Mm-hmm.

And they're actually, a lot of them are kind of older, so they're probably doing delayed core clamping right away, core traction, Pitocin, all the things.

The studies were kind of.

Low as far as quality of evidence.

Quality, Yeah.

So we still have a recommendation from like our governing bodies that Pitocin is recommended, because some of those studies show that Pitocin use did reduce the amount of blood loss overall.

Mm-hmm.

So it's something that I feel is.

Something I should bring up with patients as an option for them, because there is some low quality evidence to support its use.

Mm-hmm.

What I have noticed is that we have kind of never looked at physiological birth in a more low intervention setting with low risk moms.

Right.

And I think there's a big difference between an induction or.

Like, you know, forceps delivery or something out.

Something that's outside of normal and a normal physiological birth.

And I don't think we can say this one thing is great for everybody, no matter what kind of birth they are having and no matter their history or anything like that.

Mm-hmm.

So I think that thinking about your risk factors for hemorrhage is important.

And it's definitely a conversation that.

I have with patients, what is the person sitting across from me?

What are their individual risk factors for hemorrhage?

So I hate to use blankets.

I don't think every birth ever should need a medical intervention.

Mm-hmm.

That just doesn't make sense to me as a provider.

So the thought process between trying to use Pitocin or trying to avoid it, what I have noticed is that a lot of.

My patients come to me with the concern that.

The main concern I actually hear from people is that Pitocin in the third stage causes postpartum depression.

That comes from, and I actually saw it circulating.

I don't know if you have, there is one study out there that sees an increase.

I think it's 36% increase risk for postpartum depression with the use of Pitocin.

And that got circulated a lot on social media.

At one point, I think I was still a doula in that.

Kind of study came out and it put a lot of fear into parents.

But I think also what it did was it brought up a lot of trauma for parents because if you think about someone who maybe had a hemorrhage or someone who went through a long induction with Pitocin.

They're already at increased risk for experiencing a traumatic birth, and therefore, by default, if you experience trauma in your birth, you are going to have an increased risk for postpartum depression, period.

And that way parents could pin it on the Pitocin.

They're like, oh, it was this drug that gave me postpartum depression.

Yeah.

And that can feel like a clear answer for people.

And I think sometimes parents are looking for a clear answer.

Why did my birth go this way?

Why did I have this terrible postpartum depression?

And.

It's easy to like try and pin it on one thing.

Mm-hmm.

I would say that looking at that study, again, very low quality.

It didn't look at, and it was a small group.

It didn't look at Pitocin one time dose.

In the third stage only, it was looking at anyone who got Pitocin during their labor.

So that could have been a 48 hour induction with Pitocin.

Which we know anytime that is going on like a super long induction.

We are possibly increasing risk for certain interventions.

Yeah.

And possibly a traumatic birth and definitely increase, increasing that risk for postpartum depression.

So there's a lot of factors that go into postpartum depression, and when you just kind of take that one stat and stick it on Pitocin use in the third stage, I think that's really fearful for parents.

And so I've been trying to steer people more into.

I also talk about my personal like provider experience with it.

I've seen people have absolutely fantastic births and had third stage pit.

And not had any issues bonding with their baby or having postpartum depression or anything like that.

So I think when you're thinking about, and you're looking at someone who has a high risk for postpartum hemorrhage, I'm like, what is the benefit to you of seeing if you're gonna bleed out, like the bleeding out and the massive blood loss?

Could increase your risk for lots of things, including, you know, your milk not coming in well and you feeling like you can't get out of bed for a week, and that could definitely increase your risk for postpartum depression.

So when we're talking about a low dose Pitocin.

After baby, and we're looking at someone's risk factors.

I think it has to be an individual conversation.

And I don't think we should be jumping to, oh, if you got one dose of Pitocin in the third stage, I mean you're for sure gonna get postpartum depression.

Yeah.

Have you seen this study?

Did you see that infographic?

Yeah.

And I'm, I feel that that wasn't a quality study and we can't assume that, Pitocin is not the enemy necessarily.

It is a drug that has saved many lives, as far as hemorrhage goes.

So we know it's a good first line defense to hemorrhage, and we know that someone with an increased risk factor for hemorrhage could definitely benefit from some early intervention.

Yeah.

Thank you for all of that.

I think it's super.

Valuable to have that Pitocin third stage conversation and almost have it be separate from Pitocin in the first or second stage conversation because so much of the research is speaking about the use of Pitocin and its possible impacts as it relates to continuous pitocin over however many hours of labor induction are going on.

And so we've had these conversations in like my Instagram stories before, where people are worried.

Like they, yeah, let's say they have an unmedicated birth throughout, don't need any Pitocin or anything like that.

And then they are thinking this.

Dose in the third stage is going to do all the things that, that continuous dosage for 38 hours could possibly do.

And I think those are not apples to apple situations, but because it's like you're saying like the name Pitocin just means all of this.

I'm like using these big demonstrative hand motions that none of you can see.

But it, it, it is, it's like.

We kind of put all of it in the same basket, and we really kind of need, I think, need to look at them differently as we decide like, am I going to enter into this Pitocin induction for whatever reason?

But also like the third stage Pitocin decision is a different one with, in my opinion, almost like different risk benefits for how they will or don't, how that does or doesn't offer value to me or.

Steal value from my experience and my second baby.

I actually kind of had this fluidity of decision making.

I came in unmedicated had, you know, you said like I've seen beautiful births that then get the third stage Pitocin.

And so I had that like let's say beautiful birth, I share about this in episode 13 too.

And then we got to the second or the third stage.

We had not put an IV in or anything like that, and so my nurse had just said, Hey, if you need one, if we want some Pitocin or additional Pitocin, like I'll just put one in.

We can go from there.

And so it was kind of this fluid, in my opinion, really lovely decision that we made.

And I ended up saying, Hey, I, I'll do the I Am Pitocin, which I think all of you guys put a pin in that.

It's good to know that you can receive, I am Pitocin in the third stage in the muscle, like she said.

And then if you have an IV and you can receive, I mean if you have an IV and then you're receiving Pitocin, they will utilize the iv.

But if you do not have an IV in, you can do I am Pitocin and then go from there.

So we did, I, Pitocin, I was bleeding far more than she or I were comfortable with.

And maybe it wasn't that bad, but we were both like.

Nope, not interested in the hemorrhage.

Put IV in and got some more.

So it was this really fluid thing.

I had no.

You know, like repercussions or negative things from receiving some third stage Pitocin.

It was a separate decision for me of like, I had this labor and, and it was a quick labor.

So to me I'm like, that's also a risk factor for me to bleed because I just had a very fast labor.

And so then we made this Pitocin decision in a almost.

Silo for the third stage.

And so I think it's important for us to think about it like that, which again, that's why I'm glad we're talking about this third stage is its own stage to be making decisions in.

And the third stage, Pitocin is one of those decisions.

So yeah, the other, okay, so.

I wanna go back to chord traction.

'cause I feel like I told you all we were gonna talk about that.

And then here we are talking about Pitocin.

But the Pitocin one I think is,

and you can't talk about, you can't talk about third

stage without talking about it.

No.

So no, we have to talk about the things.

Yeah.

Yes.

And probably most of your, like the Pitocin combo is bigger to you than the chord traction combo when it comes to this, part of labor.

But, so the cord traction you've mentioned essentially is some tugging on the cord, right?

Can helping the placenta deliver by adding some traction, some tugging.

So why don't, I'll just let you go.

What were you kind of getting at with this reel where you said, Hey, I'm tugging on her cord and nothing bad is going on.

What were you trying to say there?

Yeah, so.

Someone who is not in the epilepsy industry.

My partner is, bartender food, like he's in the industry and so they get certain things that I will never get 'cause I, well, I was a server for a very brief time of my life, but he was in it for a long time, bartending so.

What they talk about things and I'm like, I don't get that.

That's in the industry.

Right.

And I always think about birth work kind of similarly.

Yeah.

If you've never delivered multiple placenta, and I don't wanna trigger people by saying delivered placentas.

But I said, I think in the comments, I was like, I've delivered some placenta.

Mm-hmm.

Like if you've never done it.

Then you don't know the difference between pulling on a cord too hard and just some gentle traction that will help release a placenta that is just stuck in the birth canal.

Mm-hmm.

So I think what I saw was people saying, never let your provider pull on your cord.

And I think that comes from experiences.

Outside of the industry where people are just having their baby and their doctor yanked on their cord like hard.

Mm-hmm.

And the cord snapped or whatever.

And then they had to do a manual removal and it turned into this horrible, eh, traumatic event, which I'm not saying doesn't happen because I was a doula for years.

I have done many hospital births.

Yeah.

And I have seen that happen.

I actually saw it happened at a home birth one time too.

So, I know that that is a thing that can happen.

But I, again, absolutes, we can't go there with birth.

Mm-hmm.

And so my whole point of putting this reel out was I've pulled on lots of cords before, like, this is not, this doesn't have to be scary.

And I think what I was noticing was moms.

Just having a baby, you are exhausted.

Yeah.

You know, you're looking at your baby.

Last thing on your mind is your placenta and you're kind of getting uncomfortable.

Eventually most people start getting uncomfortable.

Like there's still a hole organ in there.

Yeah.

You can feel, yeah.

And it's probably just sitting, because most of them detach pretty quickly.

Yeah.

It's probably just sitting there in the birth canal, like in your vaginal like area in a little dip in there, and it's probably right against your tailbone and it feels awful.

Like you just wanna get it out.

People had this fear about me helping get, like helping it come out for them.

And I wanna clarify, this is after the placenta is detached.

Detached, right?

Like it can just sit there.

And I don't think people realize that, that it can completely detach and then not just fall out of people.

And that happen Absolutely.

But most of the time I see, especially if you're leaning back mm-hmm.

You don't really have gravity on your side, so it's just sitting there Yep.

In the vaginal canal and it's, it's big and uncomfortable and people always kind of like, oh, and they get more crampy.

Crampy,

yeah.

And they're like, oh, just get this out of me.

But they were fearful about me doing anything to help because of this fear of.

Increasing risk for hemorrhage, leaving parts behind, and there's a big difference between a placenta that's detached and just sitting there and trying to work out a placenta that's not ready to come yet that is still attached to the uterine wall.

That that is completely different.

Yeah.

So.

I think that separating the two was important for me because a lot of moms, when I can give them, some of them will just push and they have amazing energy after birth.

I've seen moms get up into a squat and like, just do it themselves.

And I'm like, yeah, awesome.

But that doesn't always happen for people and especially, yeah.

After a long birth or something, you're just tired.

You're like, I'll, I'll say, can you gimme a push?

And they'll be like, I just pushed out a baby.

I'm not pushing.

I can't do anything.

Pull that out too.

Totally.

So I feel like sometimes leaning on your midwife, I, I recently.

We had a conversation over dms with this person.

I love her.

She's a, she's a labor and delivery nurse.

And she was like, we're friends.

We're not your enemy.

And sometimes I just wanna be like, I'm your friend.

I'm not gonna do something.

I don't wanna hurt you, that I don't wanna hurt you and I don't wanna cause pain.

Or, the last thing I wanna do is cause something where I have to do a manual removal.

Why would.

Having helped women with their placenta, I know it to be useful as a tool.

Mm-hmm.

That if someone is just needing a little help, and I talked about it in the reel as you know, a tampon.

Yeah.

I have pulled up right here.

You can't just push those out sometimes, you know, you actually give that string a little tug.

Right.

And then it comes right out.

Totally.

And that is what I would say.

Most midwives and doctors are doing when they're doing a little bit of gentle core traction is giving it a little bit of a help so that you are not getting up into all sorts of crazy positions.

Some placenta are just sticky.

They're just sticky in there, and they're completely and big.

Like you said, some are so big.

Yeah.

That they're, they're in there.

Yeah.

Yeah.

And so, one thing you know, that I'm looking for is that cortisol pulsing.

So that to me means it's detached.

Like there's no blood going through it anymore.

And that.

I've seen a little bit of a separation gush, which is kind of like when that placenta detaches from the wall, you are gonna get a little bit of gush of blood, which is completely normal.

It doesn't mean a hemorrhage or anything.

I think some people, especially in the pool, they'll see it and they'll be like, oh, I'm bleeding.

And I'm like, no, that's just a little separation.

Gush, totally normal.

That means your placenta is detaching from the wall.

And then you look for kind of the core to lengthen a little bit.

Right?

That's good sign too, that it's detaching.

Right.

We look for all those signs.

It's not like we're just going in there pulling out the placenta, and I think this is where provider trust is really important.

Mm-hmm.

Because you're not gonna be thinking about all those things.

You are not gonna be like, well, is there core lengthening?

Right.

Have I had my separation?

Gosh, yet.

I mean, maybe I would.

Yeah, I know,

but most people, no,

most people are not thinking about that.

And so I think it's really important to talk to your provider about what their routine is and what signs are they looking for to know if there's time for core traction.

If they're, if they, and I would say if you do not want any core traction fair.

But you may change your mind.

Mm-hmm.

Because there may be a point where you're like, this is really uncomfortable.

I don't really feel like getting up into a squat right now, or walking to the toilet.

And if you could just help me and I will say.

You have to pull really hard.

Mm-hmm.

I don't think people realize how hard you have to pull to snap a cord.

It's,

mm-hmm.

Those cords are strong and you have to be like with all your mic.

Like I saw a doctor, you know, minutes after the baby was born, he was just pulling with all his mic and it, and it was like his arm was shaking and he was a big guy.

It like makes me cringe

inside.

Yeah, that is, so think about different from gentle core traction mm-hmm.

With all the signs that placenta has separated.

Mm-hmm.

And for me personally, I don't really like to use a clamp because it doesn't give me the biofeedback of what's going on when I can actually feel the cord.

Mm-hmm.

I have felt a cord begin to tear and I've instantly stopped.

You can feel it if it starts to feel like it's kind of like still attached to the placenta and everything's giving way.

Mm-hmm.

You can absolutely feel it if you are pulling too hard and nothing is happening and you don't feel anything give, you know, to stop.

Mm-hmm.

So it's not like it just.

Will happen out of nowhere.

Mm-hmm.

Mm-hmm.

It's either a provider being too eager and just pulling without any care for what is going on as far as the placenta detaching.

Another tool we sometimes use is if someone and I kind of talk about this, like I have fine for people to wait for their placenta to come out.

Yeah.

But if there's any excessive bleeding.

We're going to plan B, we're not waiting for that placenta.

'cause now you have an entire organ in there and you're needing that uterus to con contract.

And if you have that big organ still in there, the uterus can't contract.

Right.

And so now we need to move to plan B.

And that's the conversation I have with all my patients is I'm really chill.

We can wait, we can hang out, let you do the squats, let you, I've waited an hour for a placenta.

Mm-hmm.

I mean, and that's pretty.

You out there.

But if there, if their vitals are normal, if there's no bleeding going on, I'm fine to be super patient with it.

Mm-hmm.

There's no reason for me to be doing anything.

But if someone is actively bleeding and the placenta's still inside, you bet you're gonna get some core traction from me.

And if you don't want that, you shouldn't hire me as your provider.

And I have that conversation with people ahead of time because we need to get that placenta out.

And if you're laying there bleeding.

You're not probably getting up to go to the bathroom and doing squats and trying to use gravity to get it out.

And if it's just sitting there and you've got a ton of bleeding all behind it that I don't even know is happening yet, it's really important to get that out.

And you know, with the whole freer thing.

the number one thing I hear about people reaching out to midwives after they've had their baby is this placenta's just not coming out.

Mm-hmm.

And it's because they're terrified to pull the cord and they call up a midwife, a midwife goes over there and is like, okay, can I do a little bit of cold traction?

And it's right there and it just comes right out.

Or people have gone to the hospital after having this amazing home birth because they can't, they're like terrified to pull on the cord.

And they just go in and they just pull it out and they're like, it's just sitting there like, you're good.

Yeah.

So I feel like sometimes even the fear can cause an intervention like going to the hospital.

Yeah.

So I wanted to kind of dispel the fear of there's a big difference between gentle cord traction with all the appropriate signs of placenta detachment.

Mm-hmm.

And pulling on it way too early and not caring about the signs of detachment.

Yeah, that's perfect.

I think like what I'm hearing in all of that is we can use traction too soon and the placenta isn't detached and in my opinion, that's probably not a great idea for most of us unless we are having bleeding, like you're saying.

And it's like we need to get, this was sent out, we, if there's traction, helping get the placenta already detached, placenta out of your birth canal.

It's like a totally, it's just sitting in there like you said.

And so it's like this little simple nuance.

Two totally different situations, but they're all kinda lumped together of cord traction is an intervention.

And then either do it or don't do it, and it's like, wait, what about if like, here's an appropriate time to do it and here's an appropriate time to not do it, and we're missing that in so many of these conversations.

So that was great.

I mean, I just think that's so valuable and like I'm even thinking back on my own bursts and.

And being at the bedside.

This was not my job to deliver any placenta, but just again, none of us are really paying attention to, oh, it's separated now.

Please go ahead and tug on it.

I would love for you to do that.

You know, like we we're not, we don't have that wherewithal.

I certainly didn't, even when I know these things.

Intellectually, I guess you could say.

So it does go so much to that provider trust too, of like, Hey, how do you handle the third stage?

Okay, cool.

That sounds great to me.

Like having a really simple conversation and then willing to be fluid inside of it if things change too.

So that explanation I think is just so valuable.

And when we started, I know I said it's like a wah w topic, but it's also, it's, it's not this, is this a stage of your labor?

And if this stage doesn't go well, you could.

I mean, some people have beautiful births and then their third stage they're like, oh, I hemorrhage and I add retained placenta and all.

And it can like, that can be the source of trauma all of a sudden.

And otherwise it was lovely.

Or you know, the reverse can be true or whatever.

So I think it's really important for us to pay attention to this stage and have an understanding of what's going on.

And then, you know, ideal scenario, we feel like we're participating in all these stages.

So that if or when, or if things do or don't happen, it's like I knew what was going on.

I felt like I was participating.

I knew what my provider was or wasn't doing.

Like that's still really valuable after the baby has been born too, so, so thank you.

I guess ultimately

it's a good convo.

I think you hit the nail on the head when you said nuance and birth.

Like we, there's just not enough of that in the, in the conversations that we're having online, there's not enough of the understanding of the nuance of different situations and birth and the different choices that people are gonna make based off of their own experiences.

And it's just almost impossible to be, to make a post saying You should never do X, Y, Z.

Right.

Ever.

Right.

Right, and equally so it's impossible to make a post and like fully address, I think everything.

So you get these people who are like, well, that's not how it went for me.

And I'm like, yeah, this is a 400 character posts.

Like watch my story, read the next reel, take a course.

Like this is not the only thing to make X, Y, Z decision.

Like we have to.

We have to understand that social media can only do.

So much.

We have obligation beyond that to ourselves too.

Yeah.

So, yeah.

Yeah, and I think people love to get it.

I have the same issue in my comment section.

It's like I posted something about losing the mucus plug and how that your baby's not just gonna fall out after you lose the mucus plug.

The mucus plug.

Mm-hmm.

Without contractions, it's not a sign of labor.

Mm-hmm.

Oh my gosh, the mucus plug is such a thing.

I wish it just, it wasn't even a thing because some people don't even know they lost it.

Yeah.

And then they're having contractions and they're like, well, I haven't lost my mucus plug.

Right.

So I'm not in labor.

In labor.

I'm like, no, it's the contractions that bring the baby.

So in my common section, it was like, well, I lost the mucus plug, and then an hour later I had the baby.

Right.

I was like, did you have, did you have contractions?

Right.

And they're like, well, yeah.

But also, of course you did.

None of these are universally true for everyone and it is funny, we get so caught up on like, well, that's not how it went for me.

And our stories are valuable.

You said that at the beginning, like the personal things we share are super valuable, but we just.

As consumers of information now, like we have to be thoughtful about putting it all together and not that one thing being like the end all to be all as we make a decision or decide what's, you know, what's best for us or whatever.

So

yeah, there are just no absolutes in birth and mm-hmm.

A first time mom can have like a, like a two hour labor that happens.

People have had it happen to them.

Mm-hmm.

But when I talk to my first time moms, I'm like.

The chances of that happening are right, almost like nothing.

So you need to prepare for the longer labor for the opposite, right?

Because that's a lot more likely to happen.

So we only know what we have, like have good data for and everything.

We can't prepare for the random stuff, and that's just kind of like.

That's just birth.

You know, you gotta, I say it's a journey and I don't know what your mountain is gonna be that you're gonna climb in your birth.

I have no idea.

No one does.

But you can do the education and the childbirth education and prepare yourself and that is valuable.

And, but we just don't know what your, your journey is gonna look like.

That's right.

That's the cool part about it in my opinion.

Okay.

Totally.

Well, thank you so, so much.

Truly, I hope, I hope people don't like read the episode title and think, oh, I'm not listening to that.

'cause I do think this is so important.

Where can people find you on social media?

Follow these snappy little reels that I like so much.

Where can they find you?

Yeah.

So, it's at me, the birth nerd.

Mm-hmm.

And yeah, that's, I'm just on Instagram.

You, I'm not on TikTok.

I can't, okay.

So I'm in my, I don't know, there's just a level there that I'm not.

I'm not ready for, and maybe I will be eventually.

One of my friends is on TikTok and she does a lot of amazing birth videos and education and she was like, tiktoks way easier to deal with than in Instagram as far as like getting your.

Your info out there and I'm just like, I can't do another app.

Yeah.

I mean, I just can't, so I'm always, we're turning into those

old people who are like, don't make me learn anything new.

I'm good.

I know.

Thank you.

I'm happy for you.

I'm good over here.

Yeah, good for you.

I can't do it.

We will link your handle in the show notes 'cause it does have a bunch of underscores people, so I'll just tell you that right now.

And then just for fun, I like to end all the conversations this way.

It could be about anything.

What is something in your life right now that is just sparking a ton of joy and making you, making you happy?

Well, that's a good question.

Hmm.

I would say right now I have an incredible team at my birth center, which I have kind of curated and also just randomly the right people have walked into my life.

And.

Birth work is hard.

And I think that having your people around you is so encouraging.

I have an incredible student right now who's primary in her last few births with me, and she's been such a blessing to me.

And and I think that I learned a lot from my students.

And then I have just some incredible birth assists and people that are just.

That show up for birth and bring the vibes.

Mm-hmm.

So I feel really grateful for that right now, that I have just the most amazing team and I get to be their boss.

And that feels like such a honor and yeah.

Yeah.

I'm just really thankful for that right now.

Yeah.

It's pretty cool.

I'm sure in any industry the people around you matter, but I think, man, when you're in a birth space that clicks whether you're the patient or the provider, it just feels so good for everyone.

So that's amazing.

And I'm sure your patients, your clients, your families are, are benefiting from that, so that's awesome.

Absolutely.

Yeah.

You'll have to vibe.

You'll have to, yeah.

Get along.

And that can be hard with a whole group of women, but

it

can, I, I think we, we've got this, there's something good about what we've got going on, so I, there's no competition.

We're all lifting each other up.

I think that's a big thing.

But I think women in business and women, like even in social media, you know, as professionals, there can be a lot of like.

Kind of backbiting and stuff.

And one of my kind of goals in my community and definitely on social media is that I am just really encouraging of other people in their work because there's room and space for everybody, and we all have different perspectives like you're.

From your nursing and I have my perspective from doing all my community birth stuff, I, I think it all has value, and I think one of the most important things is that we recognize in the birth space that everyone who comes in, whether that's an OB or a nurse, or a home birth midwife, we all have value and an important perspective to bring to the table.

You're right.

And it's a privilege, honestly, to get to share yours too.

So thank you truly for joining me.

You made a drab conversation a lot more fun, so thank you.

Okay, good.

Thank you so much for

having me.

It's been great.

Of course.

Thank you so much for listening to the Lo and Behold podcast.

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