Birth, Baby!

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Welcome, this is Birth, Baby.

Your hosts are Ciarra Morgan and Samantha Kelly.

Ciarra is a birth doula, HypnoBirthing educator, and pediatric sleep consultant.

Samantha is a birth doula, childbirth educator, and lactation counselor.

Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.

Let's talk about the Golden Hour.

Today, we're going to talk about what it is and what it looks like from the parent's perspective.

There'll be an episode that follows this one where we're going to go into the Golden Hour from the baby's perspective.

So let's dive in.

Okay, first, let's just talk about what the heck it is.

So you will hear people talk about different stages of labor.

And the Golden Hour is basically after your baby is born and after the placenta is born.

So I'm going to break down what the different stages of labor are.

The first stage of labor is anything from zero to 10 centimeters dilation.

The second stage of labor is from when your 10 centimeters dilated until when your baby has been born.

And then the third stage of labor is from when your baby has been born until your placenta has been delivered.

So the golden hour is that hour after your placenta has been born.

This is a time that's really, really fragile and delicate for parents.

And we want to make sure that we really protect this space.

And doing so can really help lessen negative outcomes.

So things like excess bleeding and things like that.

So when you hear about the third stage, that's usually the one that people hear mentioned the most, the one where it is the baby born to when the placenta has been delivered.

And that can take some time.

And depending on your provider, they may be okay with taking a certain amount of time, maybe not very long.

Some are like, okay, let's wait a little bit longer and allow it to happen.

So Samantha's going to break down for us what the different management models of the third stage look like.

So you can kind of decide what you might be comfortable with.

So there are three different kind of typical management styles of the third stage of labor.

And there's going to be some variation between different providers and what they do and how they address those things.

So if this is something that is really important to you, I always recommend bringing it up with your provider, your specific provider who was there that day to kind of figure out what they normally do, what they are comfortable with, because there's going to be so much variation between each provider.

So the first one that we have is what we would call expectant management.

So expectant management is when the provider is kind of sitting back and allowing the breathing person to deliver the placenta kind of all on their own.

So typically this would include that dim lighting, we're not having like, you know, that bright spotlight shining down on mom.

They aren't, you know, they are not pulling at the placenta, they're not pulling on the cord, we're not doing a whole lot of fundal rubs or running any sort of medications.

We're just kind of waiting for the placenta to deliver on its own.

Typically with this model of care, the placenta is going to deliver within about five to maybe 30 minutes after the birth of the baby.

After about 30 minutes, we're probably looking at some more intervention because the risk of additional bleeding does go up the longer that the placenta stays in.

So that would be the expectant management of care.

This is what you're typically going to receive when you have the midwifery model or when you have just kind of a more hands-off provider.

Yeah, we do see this sometimes in a hospital setting.

There are a couple of doctors and OBs that we refer to in our area.

So it'll be really important to just ask questions to your provider about what their management style is for the third stage of labor.

And they'll probably be pretty impressed if you're saying, what is your management model for the third stage of labor?

Yeah, and the next stage of labor, and this is the one that we most commonly see in the hospitals, like she said, we do see some who are practicing more of an expectant management style, but mostly we're going to see more of the active management.

So active management would be that as soon as the baby is delivered, the provider is applying some cord traction, which sounds exactly, it is exactly as it sounds, they are applying a little bit of pressure to the cord to help the placenta to deliver.

In a true active management style, they're going to be using that cord traction.

They're going to be doing a fundal massage to basically get the uterus to release from the uterine wall, because there's not a whole lot we can do to force the uterus to release.

Placenta, placenta to release from the uterus.

Placenta, not uterus.

Your uterus is not coming out of you.

I hope not.

Important note, the placenta.

So we want the placenta to release from the uterine wall.

And so they might be doing some fundal massage to get that placenta to detach.

And then they would be applying the cord traction to basically deliver the placenta for you.

Most providers, as soon as the placenta is delivered, are going to run Pitocin.

So typically what we see most commonly in the Austin area hospitals, and I think is fairly common across the United States, is they run about a bag of Pitocin after the placenta has been delivered.

There are some providers who might run the Pitocin a little bit sooner, like maybe as the placenta is detaching, they have you start running the Pitocin or then start running the Pitocin.

And the reason that they do it this way is that they feel that the quicker they get the placenta out and the quicker they get the uterus to clamp down, the less risk of bleeding that you are going to have.

Because when we're talking about like a postpartum hemorrhage or additional bleeding after a baby is born, that risk happens after the placenta is delivered.

Because placenta is going into the uterine wall and there's all these like blood vessels that have been feeding your baby.

And we need the uterus to kind of shear that placenta off and then to clamp down on itself to stop the bleeding.

So if the uterus does not clamp down quickly, then we do see a good bit of bleeding afterwards and that can be dangerous for the mother.

So that's kind of the active management model.

This is what most obstetricians are taught and this is what a lot of them practice.

Okay, now I'm going to go a little bit.

I feel like we're on the midwives cauldron right now because I'm the one who's going, okay, I'm going to say something that maybe I shouldn't say.

But in class, I often have people go, if you're saying expectant management is fine, why are so many providers in hospital so wanting everything to be pushed more quickly?

Why do they want to rush everything?

And that's kind of the way that people will look at it as being rushed.

But I do want to say, I don't think that this is like the fault of the providers.

I don't think that it is coming from a place of, they're not wishing any ill will, they're not trying to harm.

However, we do have to remember that this is a business.

They are running a business, they are in a hospital, there are a lot of people having babies.

Here in the Austin area, we are overrun.

There are constantly people that have induction schedule that are called and told, oh, don't come in yet, we don't have room.

So think of it from a business perspective.

First of all, the doctor can't leave the room until your placenta has been delivered.

So they have to wait.

And if they are waiting for your placenta to be delivered for 30 minutes, instead of getting it to come out at five minutes, that's an extra 25 minutes that they spent in that room.

And if somebody is pushing in the other room, they may be having to pay a hospitalist to go in there and help them with that other delivery.

And then that person doesn't get their doctor, right?

So that's one piece of it.

And then another piece of it is, when they're doing the active management with Pitocin after the placenta has been delivered because they're trying to reduce the risk of postpartum hemorrhage, that is so, yes, so that you don't bleed too much, but they have to come back in if there's too much of a hemorrhage going on.

So now that doctor had already moved on to another room, they already kind of checked your box off, and now they're having to come back in.

So it does make their job harder and it kind of makes them go in more, be pulled in more directions.

Now, I always say in my birthing class, it is not your job to make their job easier.

So if you don't want prophylactic Pitocin postpartum, you can tell them that and say, I only want it if I am having too much bleeding.

But then there are also some people that do want prophylactic Pitocin and they do want to reduce the risk of that because everyone always, if you know me, you know I always say, I'm going to give both sides.

And if you do bleed too much and you might feel extra tired, you might not have as much energy, you might have more of an issue with breast milk production because you're dehydrated, because your body's still trying to recover so much harder.

So there are some benefits definitely to not bleeding too much, but it is a standard procedure for them to run Pitocin in most hospitals, well, in all of the hospitals in the Austin area, it's just what they do.

So ask your providers, ask what the hospital's policies are and always remember that in the end, it is your choice as to whether or not you're going to say yes or no to not being allowed.

Okay, I interrupted you, go ahead, Samantha.

I'm off my soapbox now.

No, I love it.

We love soapboxes here.

So we talked about the active management, expectant management, there is a middle ground and we do see a lot of providers that do practice this more middle ground approach.

So we would call this a mixed management style, which is where they're kind of combining different aspects of the active management versus an expectant management.

So typically what we see when we're talking about mixed management is we see the provider, when the placenta, or sorry, when the baby is born and placed on the mother's chest, we see the provider kind of just sit back for a little bit and give a certain amount of time.

Everybody is going to have a different kind of prescription for what their time is, but they're going to kind of sit back, let it happen.

They might apply some light cord traction to encourage the placenta to deliver, but they're not kind of like reaching in there and swiping around or grabbing at the cord and trying to yank anything out.

They're waiting for the placenta to release on its own.

And then they would still help you deliver the placenta by applying that cord traction so that you aren't actively having to push out the placenta.

And then typically with that mixed management style, we do still see that prophylactic Pitocin after delivery.

So why do these different things matter?

I touched on it briefly, but the risk here is of a postpartum hemorrhage which can be caused by what we would call a retained placenta, which is where your placenta does not deliver in the prescribed amount of time.

Different providers are going to have different times for what they would consider a retained placenta.

Typically, it's anywhere from 18 minutes to an hour is what would be considered a retained placenta.

Most providers...

This stuff makes me laugh.

Most providers, after about 30 minutes, are going to start getting a little bit more active.

And I'll be honest, I don't really know the exact rates of what the increase is right there.

You know, like if you wait for 20 minutes, what's your risk of a hemorrhage?

If you wait for 30 minutes, what's your risk of a hemorrhage?

Those are great questions to ask your provider and kind of talk through with the professionals who went to school for this.

And I'm sure it's somewhere on evidencebasedbirth.com or I'm sure she has a podcast about it.

So shout out to EBB.

Don't doubt it.

She's so good at that.

Yeah, absolutely.

Did we miss anything on the different management?

Are we ready to move on?

I don't think so.

I think those are, that's kind of the basics of active management, expectant management, mixed management.

Again, if you have questions about these things, just talk to your provider about it, your midwife, your OB, whoever it is that you're seeing, ask them about it.

They're the professionals and they are going to have a lot more information than the two of us.

And I also like to tell people, if you ask questions like this to your provider, not only is their answer important, but the way they behave when they're answering your question is important, no matter what you're asking about.

So let that speak to you.

Pay attention to their facial expressions, pay attention to their tone of voice.

Are they annoyed that you're asking this?

Because they shouldn't be.

They should be glad that you care enough to be an active role in the whole process of everything and understand what's going on.

Okay, so what medications are offered?

Well, we just talked about Pitocin, that's offered.

We also have pain management options for if you have a repair that needs to be performed.

So if you have any sort of perineal or labial tear, you will have an option for pain management.

Now, if you already had an epidural, if it's still strong and feeling good, you may not need any additional pain management for a repair.

You know, most people do need some sort of repair.

It's very common to have at least a first degree tear.

Second degree is fairly common with first time moms.

And I don't want that to scare you.

It's just your body opening the way that it wants to open and not something to just like dread and freak out about.

But they're able to manage that whether you're at a hospital, home birth or birth center, they usually can repair wherever they are.

They're occasionally a high enough degree tear at a home birth or birth center to need to transfer, but that's really unusual.

So if you don't have an epidural and you need pain management during a repair, you would use, they have lidocaine that they can use.

You can have obviously ibuprofen is an option, but it probably won't kick in fast enough to help the repair.

And then also there are, but they have ibuprofen that has narcotic in it as well.

And then nitrous is a great option.

So I was actually at a birth last night where the mom had no pain management throughout labor other than, you know, a doula and things like that, but no medical pain management.

And after she had her baby, she needed a repair.

And it was just a first degree, nothing too big, but she did need lidocaine to be able to repair that.

And they said, hey, I know you didn't use nitrous during your labor.

We were at a birth center.

They're like, but you can use it now for the repair if you want, since dad's doing skin to skin.

And she's like, actually, yeah, I do want to do that.

Enough of this no pain management thing, let's do that.

So she had kind of earned that, right?

And then she used that and it really helped her through her repair, it helped her relax enough through it.

So those are the options for pain management.

And then it's also really normal for you to have kind of afterbirth pains or sensations, waves.

Your body should continue to contract back down.

We want your fundus to contract back down.

Your uterus has a lot of downsizing to do in those weeks after you have your baby.

So very common that when you're nursing, if you choose to breastfeed, you will likely feel contractions during nursing.

And I will say that the more babies you have, the more intense those after sensations can be.

I don't even think I noticed them with my daughter, but with my son, I was like, what is this nonsense?

And I would actually take ibuprofen throughout the day just to manage my after waves from my son when I was nursing, because it started to make me not want to nurse.

I was like, I'm ibuprofen it.

So that's also an option.

Yeah, they definitely get more intense the more babies that you have.

First time moms normally are like, oh, it's just a little thing.

And third time moms are like, oh my goodness.

But I will say, it's not like transition level waves that you're having at this point.

It's not like they're crazy hard labor contractions.

It's like cramping, uncomfortable.

It's almost like when you're doing a bunch of sit ups and your abs get really sore.

I feel like that's what it felt like to me with my daughter, and with my second baby.

Kind of feel like it's just early period crampiness.

And what's funny is labor sensations are more intense than that, but you're expecting to have them.

And when you're having the after birth sensations, you're like, hold up, thought we were done with this part.

Nobody told me.

So now you can't say nobody told you because Birth, Baby!

just told you.

We told you, that's right.

So what happens if we do have additional bleeding after Birth?

Because sometimes it does happen.

There are certain things that put you at a higher risk for hemorrhage.

So when you're talking, going back to management styles, when you're talking about management styles, it's a good thing to know what your overall risk of hemorrhage is based on how your labor is going and just your risk factors as a person.

So what happens if you do have a hemorrhage?

There's a lot of different medications that we can, that your providers can use to address those issues.

So the first line of defense is always going to be Pitocin.

So they would run a bag of Pitocin or they might give Pitocin intramuscularly.

And this will, Pitocin is, it's oxytocin.

It's going to help your uterus to clamp down so that hopefully we can get that bleeding to stop.

I'm about to argue with you.

I'm interrupting.

Sorry, synthetic oxytocin.

You are-

Okay, you already knew what I was going to say.

I'm like, Pitocin is not oxytocin.

Can I give a quick little why?

Is that fine?

Is that appropriate here?

Okay.

Here's why.

Why is Pitocin not the same as oxytocin?

Because Pitocin, which is a synthetic form of oxytocin, and I am very glad we have it because we do need it sometimes.

But what it does is it fills those oxytocin receptors in your body, but it does not cross the blood brain barrier.

So that oxytocin love hormone that makes you feel good and loved and all gooey gooey, that is the really nice part about oxytocin.

Pitocin only does the contracting back down part, which oxytocin also does, but it's just being used to manage the bleeding, not to also make you feel good.

So all of that lovey-dovey stuff is not used in conjunction with that when it's with Pitocin.

And that's kind of the bummer, because your oxytocin receptors are getting filled up, but they are not getting filled up with the feel-good stuff.

The Pitocin is making your body think that you have enough and it's doing its job, but you're not getting the benefits of the emotional piece of that.

Absolutely.

Yeah, they are different medications.

I think I would say, especially in labor, I think postpartum, it can be a little bit different, though there is absolutely still some of the same stuff going on there, but postpartum Pitocin can be a little bit different and that's just kind of how you react with it and what it does.

But so yeah, Pitocin is going to be kind of the first line of defense in, you know, when we're looking at additional bleeding.

We're also going to see fundal rubs, which we're going to talk about more in a minute as well, but this is basically them just kind of stimulating your uterus.

Mashing your stomach.

It is not a massage.

It's not a massage.

Sorry, one more thing about Pitocin.

Did you say that it can be given intramuscularly or by IV?

Did we touch on that?

Okay, good.

We talked about so many things with Pitocin.

I just want to make sure.

So last night, we were able to get it IM, intramuscularly, into her leg.

But then, like later, she was kind of wondering, did I, am I still bleeding too much?

And they're like, no.

And she's like, I'm just worried.

And they said, if you want us to put Pitocin in your bag of fluids, we absolutely can.

And she's like, okay, I'm going to think about it.

And that's nice to be part of the conversation, to be part of like, it was going to maybe give her more peace of mind.

And that's okay, too, you guys.

Just because we're saying it's not always medically necessary doesn't mean you can't still make that choice for yourself.

Absolutely.

Absolutely.

You are a big part of the decision-making process.

And that is informed consent.

Right then or that's what that is.

So after Pitocin and fundal rubs being kind of the first line of defense, typically what they're going to go to next is a medication called Cytotec, which in most cases, they're going to administer rectally, which is not as awful as it sounds, I promise.

You typically are not even really going to feel it.

But they would give you, I think it's normally like two to three pills, sometimes more, just right in your bottom.

And it's another medication that can help your uterus to contract down and clamp down on those blood vessels that are bleeding.

The way that was explained to me when they did it to me was that Pitocin and Cytotec work at a different rate.

So one works more quickly and one's more long acting.

And so they gave them to me both at the same time because of the intensity of my hemorrhage.

So this is even at a birth center, you guys, that they can do this.

So there are options everywhere, which is really nice.

Right.

Exactly.

Typically, again, every provider is going to be different in how they treat things.

But if they've done those things, we're still having some extra bleeding.

Normally, the next thing that they're going to offer is a medication called TXA, or I'm going to probably just absolutely botch this, but it's called a tranhexamic acid.

Look it up.

You can probably figure out a better way to pronounce it than I can.

Don't at us.

Yeah, do not.

It is a medication used to treat or prevent blood loss from a larger trauma, like that postpartum bleeding or different things like that.

So that can be a really beneficial medication that they can offer at that point.

Then there's also something called Methergine, which is sometimes used.

And in recent, I don't even know how long this has been around.

I think it's mostly come around in the last year or two.

There are some devices that they can actually use to treat those bleedings.

There's something called a Jada device is one brand.

I think there's a couple of different options out there, but it's almost like a balloon.

This is my understanding of it.

It's almost like a balloon that they put in your uterus to pretend like your uterus is stopping that bleeding.

So in my understanding, it doesn't actually help your uterus to clamp down, but it will stop the bleeding artificially while they figure out how they can get your uterus to clamp down.

So those are some of the options.

There's more coming out all the time, more different devices, different medications.

But those are the ones that we personally have had experience with in our practice and what we see being used most commonly.

Yeah, and disclaimer all over the place, we're not medical professionals.

We're just telling you from a dualist perspective, like what we've seen used and as childbirth educators, what we teach about.

But when you want to know the risks and benefits and when and why all of these things are used, again, ask your provider.

That is completely appropriate to ask them even preemptively and at an appointment, hey, in case of hemorrhage, what things do you have on hand?

What is the order of the things that you use?

Those are all questions to ask them.

So this is just kind of a starting point to get that conversation started for you guys.

Absolutely.

So tell us about fundal rubs.

Oh, man, I've heard them called fundal massages.

And I'm like, that is just the most rude massage ever.

Well, let's not call it that.

This is another thing that I've had people say, nobody told me about this.

And I've had somebody else.

I've also heard people say, just don't tell people.

We don't want to not look forward to it.

But I'm a big believer that everything is more tolerable when you have information ahead of time.

So what they will do is after your baby is born, they'll hopefully the person's nice when they do it.

And they tell you to take a deep breath and start letting it out.

And they will press down on your stomach around where your fundus is, or they're looking for your uterus to make sure that it is contracting back down and getting hard.

So things like if you have a baby very quickly and you're like a super fast labor, sometimes your uterus is like, what?

There's not a baby in here anymore.

And it kind of needs a little boost of, hey, you're supposed to contract back down now, okay?

Or if you had a really, really, really long labor and your uterus is just exhausted and it's been working for a really long time, once the baby comes out, sometimes it's like, hey, yo, I'm too tired to be messing with all this.

Help me out.

And what happens if that's not contracting back down is that your bleeding is stronger and you're having clots and things like that.

So a fundal rub is a way for your provider, they push on your belly, they rub around and they see if your fundus is hard.

And if it's not, they're going to continue rubbing and try to get it to stimulate to contract back down and then that will also help them know, hey, maybe we need a little bit of help from one of those other medications that Samantha just talked to us about.

And they'll usually do this like every, it's usually every 15 minutes right after birth and then they space it out a little bit further and a little bit further.

It's also something that you can ask them, hey, can you show me how to do this so I can do this for myself?

I remember when I had my daughter in the hospital, you know, I was 24 and I have a really weak stomach in general and I was young.

So it was like a bad combination.

And they're like, oh, here's how you do it.

I was kind of surprised.

They were telling me and I was like, hey, we're paying you for me to be here.

You rub it, I'm not doing this.

And I looked at my ex-husband and I was like, there's no way I'm doing this when I get home.

This is so gross.

Like it grossed me out because I'm a wimp.

But some people prefer rather than having someone else touch on their stomach, they want to know how to do it and they want to feel it.

And I've had some midwives and nurses, cause it's not usually the doctor doing this.

They're usually gone by then.

But I've had some midwives and nurses go, hey, do you want to feel what it feels like to the mom or the person that's giving birth?

Do you want to feel what it feels like when it's hard?

This is what it should feel like.

So if you ever rub around in your stomach and it doesn't feel like this, here are some things that you could do.

I think that's great that they get people involved in their own recovery.

Yeah, cause there's some things that you can do.

Like, you know, if your bleeding is increasing in that moment, there's some things that might be why your fundus is not where it should be or how it should be.

Like sometimes if it's off to the side, that might mean that your bladder is full and that it's literally pushing it off to the side.

And then you go pee and empty your bladder and then it's able to kind of clamp back down again.

Literally 1:30 a.m.

last night.

That is exactly what happened.

She was like, your uterus is just a little off to the side.

I'd really like to get us up and have you pee.

And that fixed it.

It was great.

Absolutely.

That was when I had additional bleeding after I had my daughter.

It was because my bladder was so full.

And when they did get me up to go to the bathroom with a little bit of drama, I was able to empty my bladder and then my uterus could do what it needed to do.

Such a little bit of drama.

Shocker that your uterus would be dramatic.

All right.

Well, tell us what to expect when, if you have an epidural, if it wears off.

And also, what do we expect if we never had any epidural and kind of what it's going to feel like after we give birth?

Yeah.

So typically after you deliver, so normally as soon as the baby's out, sometimes they wait until after the repair is done, they're going to go ahead and turn off your epidural pump if you have one going.

It just doesn't mean that the epidural is going to wear off immediately.

So that's why it would be okay for them to turn it off after the baby's born because you'll still have a good bit of numbness for a while they do a smaller repair.

If you have a little bit of a more complicated repair or anything else going on, they'll probably leave it on for a while longer, which can be really helpful.

But in most cases, the epidural is going to wear off about an hour or two after they turn it off.

And when that epidural has worn off, the goal in, we call it recovery, recovery is for you to get up to pee, to kind of get yourself cleaned up a little bit.

I will really, you're not getting yourself, you have your midwives or your nurses or whoever helping you with that.

And maybe putting on a new nightgown to go to postpartum or to be snuggled back into your bed or whatever it is.

But that's going to happen about an hour or two after you have the baby.

If you're in the hospital, most of the time after you get up to pee, they're going to then put you in a wheelchair that they would wheel over to postpartum because they don't want you walking down the halls of the hospital right after you had a baby with some blood loss and different things going on.

And you don't want to do that either.

You're tired.

You deserve to be treated like royalty and rolled around where you need to go.

So that's normally what's going to happen after you have a baby.

If you're at home or you're in a birth center, they're going to get you up to pee.

They're going to get you cleaned up a little bit.

Maybe get you a quick shower and then help you back to bed so you can spend time with your new tiny human.

Yeah, at a birth center, you typically leave around the six hour mark.

So head on home.

I texted the family that I was with overnight last night and I was like, hey, are you guys home yet?

He's like, yep, just trying to get little bits of sleep here and there.

And I was like, oh, I just love it for them that they're already home.

And you may have a little bit more soreness because you did have to get up and walk out of the birth center and sit in a car and drive home depending on how long that is.

But typically people heal a little bit faster when they didn't have an epidural because their body's not trying to process the anesthesia.

In a hospital setting, sometimes you do feel a little bit more wonky and a little bit more sea-leggy after having an epidural.

So even if you did or didn't, you usually need help getting up to go to the restroom for the first time.

Like even last night, we were assisting her to walk over there because you can get lightheaded, like Sam was saying.

And it's not always, sometimes your body goes into a little bit of shock after having a baby.

Like, holy moly, I did it.

No matter how you did it, I did it.

So it'll depend on how many medications were used and what type of delivery, whether vaginal or cesarean, as to whether or not you're able to move around a little bit more on your own.

I do find that people that have an unmedicated birth, although they're finding that they're healing more quickly, it's a little bit harder for them to stay stinking still and they get up and they do too much.

So the midwife last night even said, and I want you to keep your legs together, you know, for the next couple of weeks, as much as you can keep your legs together.

And it sounds so funny, but it's like, well, you want everything to heal.

You want to be in on around the bed for the first long time.

Yeah, mermaid legs.

I like that.

I hadn't heard that before, actually.

So whatever way that you give birth, you may have a little bit of a different experience with what to expect right after, but that should run the gamut there.

Yeah, absolutely.

So next time, we're going to talk more about Golden Hour, kind of from the baby's perspective and, you know, the breastfeeding and all those different things, medications for baby.

So join us next week when we get into more of that.

Thanks, y'all.

Thank you for joining us on Birth, Baby!

Thanks again to Longing for Orpheus for our music.

You can look him up on Spotify.

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See you next week.