Third Stage Information
The third stage of labour includes the time after the baby is born up to the delivery of the placenta. There are 2 options for managing the third stage of labour:

1. Expectant (Physiologic) Management: Your baby will be skin-to-skin with you as soon as they are born with warm blankets placed over you both. This allows transition time for the baby and for release of your own oxytocin to help with birth of the placenta. During this time, your midwives will be monitoring your baby’s transition as well as any signs that your placenta is ready to come. Some people will feel cramping as the uterus contracts as a sign that the placenta is separating. Sometimes we will see what is called a ‘separation gush’ of blood as the placenta releases. You will be encouraged to push when you feel the contractions to help the placenta deliver. Your midwife may assist you to sit up to help the placenta delivery. It is expected that the placenta will deliver within 30 to 45 minutes of your baby’s birth. If there is any concern your midwife will discuss changing to active management.


2. Active Management: Active management is the standard of care in the hospital and the most common management of the third stage of labour. The Society of Obstetricians and Gynecologists of Canada, World Health Organization, Canadian Association of MIdwives and numerous other worldwide organizations recommend active management of the third stage of labour to help prevent postpartum hemorrhage. Active management involves the injection of oxytocin into a muscle, putting gentle traction on the cord, and massaging the uterus after the delivery of the placenta. Oxytocin is the hormone that causes contraction of the uterus. Following the birth of a baby, contraction of the uterus helps the placenta separate for delivery. Oxytocin can also help decrease the risk of hemorrhage in the first 24 hours following your baby’s birth. Some people will experience nausea, vomiting and cramping following active management.

Management of the third stage of labour will be discussed during your 36 week visit.

• American Pregnancy Association - Third Stage of Labor
• Queensland Government (Australia) - Third Stages of Labour
• UK -NCT - Third stage of labour: delivering placenta and cord clamping
• Ontario Midwives - Postpartum Hemorrhage, An AOM Clinical Practice Guideline Summary.

Herpes Simplex Virus 2 (HSV2)
If you have a history of HSV2 it is recommended that you take Valcyclovir from 36 weeks until your baby is born. Taking the medication will help to prevent transmission to the baby during the birth. Your midwife can give you a prescription for the medication at your 36 week visit. For more information about HSV2, please see the link below.

• Society of Obstetricians And Gynaecologists of Canada - Herpes.

Birth Supplies List

• A shower curtain or plastic paint tarp to cover the delivery area
• 2 Large garbage bags
• Medium sized bowl/ Ice Cream Bucket for the placenta
• 8-10 clean washcloths, used for warm perineal compresses
• 5-6 Older Towels
• Incontinence pads (puppy pads)
• Soaker Pad (great to use in the bed, and is awesome for potty training a toddler later on!)
• 2-3 disposable mesh underwear (are nice to have postpartum)
• 3-5 Receiving blankets
• Hat for newborn
• Small bottle of unopened olive oil/ almond oil/ avocado oil (the oil is used during crowning for delivery)
• Small bottle of hydrogen peroxide (for cleaning if needed)
• 1 package of long overnight pads (Kotex/ Rael) *note: please DO NOT buy Always brand as they are plastic and can cause irritation after delivery.
• Fish Net (If planning water birth)
• Digital thermometer (Vicks or Braun’s are great ones)

Suggested List

• Homeopathic Arnica
• Squeeze bottle for peri-care
• Calendula Tincture

A great place to buy birth supplies is Birth Supplies Canada Inc.

Preparing your Bed for a Home Birth

• Keep your normal fitted sheet on your bed, then place the plastic tarp on the bed. Put some old sheets on the bed that you are ok to give birth on.
• Don’t do this until early labour.

Hospital Bag List

• Outfit to wear in labour if you want (there will be hospital gowns at the hospital)
• A comfy outfit to wear home
• Lip balm
• Toiletries
• Slippers or flip flops
• Newborn outfit (undershirt, sleeper, socks, hat)
• Newborn hat
• Music speaker if desired
• Phone Charger

Have the car seat installed in your car.

Although breastfeeding is natural, sometimes it takes time to learn. It is a learned experience between both you and your baby. Give yourself grace as you navigate this journey and know that you are doing a great job! Your midwife is here to support, please call the pager if you are needing support with getting a comfortable latch.

• UpToDate Breastfeeding Guide
• International Breastfeeding Centre

If you are concerned you are experiencing a miscarriage please call your midwives on the pager (403-214-7557 Opt.1).

What is a miscarriage?

• A miscarriage is defined as a pregnancy loss before 20 weeks gestation and occurs in 20% of pregnancies. The medical term for a miscarriage is spontaneous abortion.

Why does it happen?

• The most common reason why a miscarriage occurs is due to chromosomal abnormalities. Other causes can include: maternal diseases, uterine abnormalities, exposure to teratogens or infection.

Symptoms that May Occur:

• Pelvic pain – this may vary from mild cramping, intense cramps or contractions
• Vaginal bleeding – it may be light or like a heavy period, clots may also be present
• Fever – temperature of 38.5 degrees Celsius or higher
• Passing tissue from vagina
• Asymptomatic – there may not be any symptoms present and the loss will be detected on ultrasound

Reasons to Page your Midwife:

• Heavy bleeding – soaking a maxi pad in less than an hour for two hours
• Passing big clots (the size of an egg or larger)
• Intense abdominal pain
• Fever
• Vaginal discharge with foul (bad) odour

If any of these symptoms are present please call your midwives on the pager(403-214-7557 Opt.1).

Most Common Types of Miscarriage:

• Missed Miscarriage – this may happen when the embryo/fetus stops developing and then weeks later the miscarriage is diagnosed.
• Blighted Ovum – this happens when there is a gestational sac but the embryo didn’t start or didn’t continue to develop.
• Incomplete Miscarriage – this happens when not all of the tissue has been expelled from the uterus, is may also be referred to as retained products.
• Complete Miscarriage – when the embryo/ fetus and all placental tissue has been expelled from the uterus.
• Less commonly there can also be a molar pregnancy or ectopic pregnancy.
  
  • A molar pregnancy is where the placenta grows into a mass that may or may not contain an embryo.
  • An ectopic pregnancy is when the embryo implants into the fallopian tube.

Options After Diagnosis of a Miscarriage:

• Your health care provider will go over different options with you and discuss the benefits and risks of each option once there has been a diagnosis of a miscarriage. Treatment options may include the following:
  
  • Natural or expectant management – letting your body try to pass the pregnancy on its own, or with help from an acupuncturist. This may include severe cramping and heavy bleeding. Advil and Tylenol can be taken to help with the pain. The fetus may appear as a white mass or it may look like a small baby with distinguishable features.
  • Misoprostol – is a medication that is inserted vaginally to help start cramping to expel the remains of the pregnancy.
  • Dilation and curettage (D&C) – this is an option before 12 weeks gestation. It is a short procedure in the OR, where the cervix is dilated and a special instrument is used to scrape the uterine lining. Usually booked within a week of the diagnosis unless there are concerns or an opening in the schedule.
  • Dilation and Evacuation (D&E) – this procedure is done when a pregnancy loss is over 12 weeks gestation.

Caring for the Pregnancy Remains:

• Options for the pregnancy remains include taking them to the hospital where they can be cremated, or there is also the option to bury them in a location of your choosing (backyard, cemetary etc), please ask your healthcare provider for more information.
• If presenting to the Emergency Department the nurses will ask if you brought the pregnancy remains and if everything has passed. Individuals may refer to the miscarriage with a number of different terms, please advise healthcare providers on how you would like them to refer to the loss.

• Alberta Health Services - Grief Support
• Alberta Health Services - Condition Basics