This is one of the frequent search terms I get, and I don’t think I’ve fully addressed it, so will do so now.
First, a brief elementary look at the placenta, umbilical cord and fetus. Within a few days after conception, the embryo implants in the lining of the uterus; part of the “conceptus” becomes a tiny placenta, while the rest of it becomes the fetus, with the umbilical cord in between. As the baby grows, so does the placenta and the umbilical cord. From what I’ve read, both the length of the cord and how much it coils depends on fetal activity; so a short cord and a straight cord are both correlated with low fetal activity. Fetal inactivity is associated with higher rates of fetal problems, so if either of these things is noted in an ultrasound, fetal abnormality is suspected. Short and straight cords may not be problems in and of themselves, but are associated with babies that have problems, although most babies are still fine with short cords. Long cords tend to be associated with very active babies — again, not a problem in and of itself, but babies can more easily become tangled in long cords, perhaps impeding birth, or if the cord wraps around the neck or tightens into a knot, can compromise or kill the baby with lack of oxygen. Long cords also increase the possibility of umbilical cord prolapse, since there is more cord that can come down before the fetal head.
The placenta is where the exchange of nutrients, waste, oxygen and carbon dioxide happens between mother and baby. During labor, the placenta keeps the fetus supplied with oxygen, just like during pregnancy; although the exchange is slowed or stopped altogether during contractions. This is why some babies go into fetal distress during labor that is artificially stimulated with Pitocin — the contractions can be too long or too close together, depleting the fetal supply of oxygen. It’s like holding your breath under water — if you can come up for air and breathe normally for several minutes, you’ll be fine; but if you can only take a quick gasp before being held underwater for another minute or two, you’ll eventually suffer.
When the baby is born, most hospitals will immediately clamp and cut the cord, although there is no reason for doing this, and the evidence simply does not support the practice. Other options include a “lotus birth” in which the cord is never cut, but the placenta is placed in a bag and carried with the baby until the cord dries up and falls off; waiting for several hours and cutting the cord (no clamp needed, because the cord begins to gel internally, cutting off the blood supply to and from the placenta, and the blood dries up); or at least waiting until the umbilical cord stops pulsing before clamping and cutting. If they don’t clamp the cord, it will be quite messy, since there is a lot of blood reserves in the placenta, and if they don’t clamp the baby’s side too, the baby can lose blood through the umbilicus.
Assuming the cord is not immediately cut, the baby is usually placed on the mother’s chest, where he may begin nursing, and where the midwife, doctor, or nurses observe the baby or give him a neonatal exam on the mother’s chest. The cord is typically long enough for the baby to reach the chest, even while the umbilical cord is intact, with the placenta still in the uterus. Usually within 15-30 minutes, the placenta detaches and the mother pushes it out.
Assuming the cord is immediately cut, the baby may be placed on the mother’s chest, or taken across the room for a neonatal exam, and other typical neonatal procedures (which you may request be delayed or not done altogether, like a vitamin K injection, eye drops or ointment, etc.). Many times, doctors will pull on the placenta to help it come out (controlled cord traction), although this is not necessary.
Once the placenta comes out, it should be inspected to make sure it is all there (occasionally a piece may be retained inside the mother’s uterus), or else the woman may experience continued bleeding, because the uterus acts as if the pregnancy is ongoing until all the “products of conception” are expelled. Once the placenta is entirely out, the uterus normally clamps down at the site where the placenta was attached, which is most easily described as a large, open, bloody spot, since that was where the fetus’s entire nourishment and oxygen supply was.
What happens to the placenta and the umbilical cord at this point may depend on where you give birth. At home births, it is not uncommon for women to choose lotus birth, to plant a tree or bush on top of the placenta (perhaps freezing it until springtime), or even to consume it (typically, dried and put in capsules; although I’ve heard of people eating it raw or cooked). If the woman doesn’t want it, some midwives or other birth junkies may save it for educational purposes — for instance, to show the next childbirth class what a placenta looks like.
In a hospital, choices may be more limited, especially if the hospital staff just follow whatever their routine is, and don’t ask or consult you. Some hospitals take samples of all placentas, as a sort of record that the placenta was healthy, should there be any future problems or questions with the baby’s health. I assume that most if not all placentas will be discarded as medical waste, and in fact have seen headlines (but did not read the story) about one couple’s fight with the hospital to be able to take their placenta home with them to plant a tree over it, which was traditional in their culture.
Here is an Australian midwife’s blog post in which she discusses the placenta, as well as has pictures of a real placenta, with descriptions.
Filed under: postpartum, umbilical cord | Tagged: amniotic sac, baby, fetus, health, placenta, postpartum, pregnancy, pregnant, umbilical cord | 11 Comments »