By Michel Odent
Excerpted from "Putting an End to Women's Global Slaughter: Bleeding to
Death," Midwifery Today, Issue 74
Over the years I have come to the conclusion that postpartum haemorrhages
are almost always related to inappropriate interference. Postpartum
haemorrhage would be extremely rare if a small number of simple rules was
understood and observed..
During the hour following birth, I remain as silent as possible and keep a
low profile. I either sit down in a corner behind mother and baby or
disappear, if there is an experienced doula present who has had a personal
experience of this situation. Minutes after birth many mothers are no longer
comfortable in an upright position. This is most likely the time when the
level of adrenaline is decreasing and when the mother feels the contractions
associated with the separation of the placenta. Then the birth attendant may
have to hold the baby for some seconds, in order for the mother to find a
comfortable position, almost always lying down on one side. After that there
is no excuse to interfere with the interaction between mother and baby.
I don't approach the cord and placenta for an hour. Clamping and cutting the
cord before the delivery of the placenta is a dangerous distraction.
Suggesting a position to the mother is another unneeded distraction. Her
position is the consequence of her level of adrenaline. When the level of
adrenaline is low and the mother feels the need to lie down, it would be
unkind and unphysiological to suggest an upright position.
It is only when an hour has passed after the birth-if the placenta is not
yet delivered-that I dare to disturb the mother in order to check that the
placenta is at least separated from the uterus. With the mother on her back,
I press the abdominal wall just above the pubic bone with my fingertips: if
the cord does not move, it means the placenta has separated. In practice,
the placenta is always either delivered or separated an hour after birth,
and bleeding is minimal, if the third stage has not been "managed." I have
never had to inject a uterotonic drug to control the bleeding.