In hospital birth, the placenta usually is expected to separate and make its appearance within 20 to 30 minutes. Even midwives at a home birth can get a little uncomfortable with waiting, mostly because they don't want to be responsible for an infection setting in. However, in an unassisted birth where the woman is responsible for her own well-being, the baby is already birthed and so she can afford to have a wait-and-see attitude because it is not going to affect the baby's health in any way.
Relax about the placenta.....Your body knows what it is doing. In many cases, the placenta sheers off from the rest of the uterus within the first few contractions following delivery. Sometimes, if labor has been particularly long and exhausting, you uterus may be resting up before contracting enough to expel the placenta. It will help after the birth, while you are holding and getting to know the baby, if you will sit upright. Just as gravity helped your baby be born, it also helps the placenta to peel off and sink to the lowest point.....your cervix. Often, while you are sitting there nursing the baby (which helps the uterus contract and the placenta to detach) the placenta will ooze out of the cervix into the vagina, where it sits until you get up a plop! it just falls out. Sometimes, you may try to give a little push to get it out, only to find that it's in the vagina and pushing with the uterus doesn't help. In that case, a TINY tug on the cord will let you know whether it's detached or not. It should just plop right out. If it doesn't, give it a little more time.
Sometimes, however, it does not detach immediately. Don't be alarmed, sometimes it just takes longer. If you have remained upright and it still feels attached, nursing the baby vigorously may help. Lie down with baby, totally relax your mind and body and feel the satisfaction of what your body has been able to do. Feel good about yourself for sticking with it and doing a good job, despite obstacles. Give yourself permission to let go of that placenta. Feel the release that comes, and visualize the placenta letting go.
Sometimes it is necessary for the placenta to let go in order for the uterus to clamp down and stop bleeding. Evaluate your flow and make a decision about whether you feel it is excessive or not. If you don't have any fever or chills, or if there is not a bad smell that would indicate infection, decide whether you feel comfortable waiting longer.
I have known women whose placentas did not come for several hours, and in one case a couple of days. I have also known women who had significant blood flow, and whose placentas came out in pieces over a period of several hours. You must do what you are comfortable with.
One suggestion would be to try some Cayenne Tincture. Wait 30 minutes. If the placenta has not been expelled, then give some Lobelia Tincture. After 30 minutes, try Cayenne again. Often this will do the trick. It's best to use your own fresh homemade tincture. Store bought Lobelia tincture is usually weak and worthless. Don't be afraid to take quite a dose. The reason herbs do not work for most people is that they don't take enough of them. The most that is going to happen with these herbs if you take too much is that you will vomit. No other bad side effects are going to happen.
Very rarely there is a condition called placenta accreta in which the placenta is actually imbedded in the uterine muscle. In that case, a surgical procedure is usually required to remove it.
More often, however, it is simply maternal inertia which stalls the delivery. Get up and walk around a little, if you aren't losing too much blood and don't feel lightheaded. Have someone walk with you in case you start to feel dizzy or unsteady. In that case, sit back down. Try drinking some fluids, and perhaps eating a tablespoon of raw, unheated honey. Give your body some fuel to re-energize the process.
During this time of waiting, you might try sitting on the toilet and just relaxing your mind and body. Sometimes your body will let go of things on the toilet that resisted expulsion in other locations. Often it's the mother's subconscious revulsion at expelling bodily fluids anyplace else except the bathroom.
Try the Accu-Balancing Technique. It often works when nothing else will.
No one can tell when it is the right time to go to the hospital. You must check your intuition, and ask your body for wisdom. If you feel at an impasse, you might first try contacting a midwife who might come over and give you a shot of pitocin. After that, your next stop is the hospital and a probable manual extraction.
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