This lesson explores the essential principles and considerations for managing the third stage of labor—specifically after a waterbirth. Providers are guided through both physiologic (expectant) and active management approaches, always centering the mother’s history, preferences, and the provider’s clinical judgment.
Key distinctions between expectant and active management are reviewed, including how to assess prior third-stage complications, the role of placental diagnostics, and maternal requests regarding cord clamping and placenta handling. Barbara emphasizes that physiologic birth continues into the third stage and encourages a hands-off approach unless intervention is clinically warranted.
Timing and signs of placental separation are explained through a simple estimation formula, as well as fundal height and cord length indicators. The lesson reinforces that placental birth typically occurs after three contractions and may require positional changes or gentle encouragement.
The practice of delaying cord clamping is explored in depth. Barbara recommends waiting one to two hours post-birth—when possible—to honor the baby’s sanctuary and prevent unnecessary disruption. This timing is contingent on the absence of postpartum hemorrhage.
Lotus birth is introduced as an option for some families. The lesson also contrasts the implications of cutting the cord before versus after placental birth and describes how and when active management (including oxytocics) may be appropriate.
The innovative Blood Loss Wine Chart provides a visual and accessible tool for estimating postpartum bleeding based on water color and appearance, ranging from White Zinfandel to Merlot. Providers are trained to combine this visual method with maternal vitals, water clarity, and fundal checks to make swift clinical decisions.
Importantly, the lesson reviews when to exit the birth pool, how to respond to early signs of maternal distress, and when to administer medications like Pitocin. Evidence from Dianne Garland’s study is also cited, showing lower postpartum hemorrhage rates in first-time mothers who gave birth in water compared to land.
Finally, breastfeeding is highlighted as a natural stimulus for placental detachment, and Barbara’s preferred homeopathic remedies—like Ignatia—are briefly introduced.
The lesson concludes with a review of best practices and a powerful video from midwife Lisa Marie Oxenham, demonstrating calm, competent management of the third stage in real time.