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The stages of delivery
The deliverance, that is to say thedelivery of the placenta after the birth of the baby, follows a very precise timing, in 3 phases. The first step allows the placenta to separate from the uterine wall. It begins after the release of the newborn, with a rest period about 15 minutes during which the uterus retracts. This causes a hematoma (blood bag) to form behind the placenta, which allows it to begin to expel.
Then begins the active phase, with uterine contractions that finalize placental detachment. Don’t panic, these contractions have nothing to do with those of childbirth and you will not feel them if you are on an epidural. To ensure placental abruption, the midwife places her palm on the lower part of the uterus, through the wall of the abdomen. Then she gently brings him up to the umbilicus. If the placenta is detached, the cord that hangs from the vulva does not come up. The placenta can then, under the effect of contractions and of its own weight, migrate through the birth canal before being expelled.
His expulsion is in the majority of cases assisted by the midwife. The maneuver consists in accompanying the exit of the placenta by exerting a slight traction on the cord with one hand and, with the other hand, in bringing the fundus of the uterus downwards. The placenta arrives and is then collected for examination.
After the placenta is completely evacuated, the uterus contracts as much as possible to close the vessels in the placental area, then, very quickly, the coagulation mechanisms are put in place to stop the bleeding. This last phase, hemostasis, ends the process. However, it doesn’t quite end there! We are monitored in the delivery room for 2 hours to control our pulse, our blood pressure, but also uterine retraction and bleeding.
Delivery: sometimes it does not go as planned …
A defect in contractility of the uterus, but also a poor insertion of the placenta or an alteration of the uterine lining may be responsible for retention of the placenta. This complication can have serious consequences. The main one is the occurrence of hemorrhage during delivery, or even within 24 hours of birth.
Retention can be complete when, half an hour after birth, the placenta has still not detached from the uterus. It can also be partielle and, in this case, an infectious risk is added to the hemorrhagic risk. This is what happens when a piece of placenta sticks to the uterus and prevents its retraction. This is why the midwife systematically checks that it is whole by examining its different faces.
The treatment of a non-detachment is to go and find the placenta manually, this is called a artificial deliverance. Likewise, if a piece of the placenta remains in the uterus, the doctor must go and remove it by hand, we then speak of uterine revision.
When the uterus stops responding
Delivery bleeding can also occur if the uterus does not contract sufficiently after the placenta has delivered. This can happen if he was too distended during pregnancy, if he was exhausted from prolonged labor or subjected to too high doses of oxytocin (a hormone that stimulates uterine contractions).
To prevent this complication and boost placental abruption, it is recommended that all mothers be injected withintravenous oxytocin, either at the time of the release of the shoulder of the baby (one speaks then of directed delivery), or after the expulsion of the placenta. But nothing like a uterine massage when it turns out a little soft! It is done after delivery to strengthen the contractions.