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The physiogirl instagram has loads of good stuff on it especially for recovery for running mothers

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video of breathing techniques for birth (there is more than one way but this is pretty good 

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video of breathing techniques for birth (there is more than one way but this is pretty good 

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BREATHING Techniques for an EASIER LABOR | How To Breathe During Labor | UPDATED

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when mum is tense or needs energy

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How do I support my partner during labour? - NCT Matters

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Useful before labour and to calm mother during labour

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Massage for labour and birth neck and head - NCT

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How to Get the Oxytocin and Endorphins flowing

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comparison of different forms of applied pain relief

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COMPARISON OF DIFFERENT PAIN RELIEF OPTIONS

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hormones are your helpers by sarah buckley

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Natural and managed third stage  what are they

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Natural and managed third stage  what are they

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What is the third stage of labour?

The third stage of labour is the time between when you have your baby and when the placenta (or afterbirth) comes out (Begley et al, 2011; NICE, 2017).

Once your baby's born, the release of the hormone oxytocin will make the uterus contract and become smaller. This'll make the placenta start to separate.

You will have some bleeding during the third stage of labour as you pass the placenta (Begley et al, 2011).

Active management versus physiological management

Generally, you have two options for how you do the third stage of labour: active management and physiological management. But there's also a third option - mixed management - combining active and physiological approaches (Begley et al, 2011; NICE, 2017).

Physiological management:

It's generally practised in midwife-led units and in home births.

It allows the placenta to be ready to come out mainly by pushing, gravity, contractions and sometimes by nipple stimulation.

It doesn't use oxytocin injections.

The umbilical cord is clamped and cut once it has stopped pulsing or when the placenta has come out.

It can take up to one hour (and shouldn't take more).

Skin-to-skin contact and breastfeeding can help it along, by making your body produce more oxytocin.

It involves sitting in an upright position to encourage the placenta to come out.

Your midwife will monitor your blood loss and keep you and your baby warm.

You'll push the placenta out once it has separated and moved down to your vagina.

It's mostly used if you're at low risk of heavy blood loss.

You can change to active management at any time if needed. (Begley et al, 2011; NICE, 2017)

When the placenta is out, your midwife will clamp and cut the cord. But if you want, you can ask them to wait until it has finished pulsating (RCM, 2013a).

Active management:

Involves an injection of a drug called syntocinon or ergometrine in your thigh soon after your baby's born.

It speeds up the delivery of the placenta - it usually happens within 30 minutes of having your baby. Your midwife will push on your uterus and pull the placenta out by the umbilical cord.

You'll have the umbilical cord cut between one and five minutes after you give birth.

Early cord clamping reduces the amount of blood your baby gets from you at birth by about 20%. But this also makes it less likely they'll get neonatal jaundice that needs treatment.

It lowers the risk of heavy blood loss.

It might make you feel sick or vomit, and can increase your risk of high blood pressure.

(Begley et al, 2011; RCM 2013b; NICE, 2017)

Should I have active management or physiological management?

Generally, active management is recommended for all women, to avoid severe haemorrhage. Though this is more of an issue in low-income countries where women are more likely to be poorly nourished, anaemic or have infectious diseases (Begley et al 2015).

If you do go through a haemorrhage though, you'll need to be transferred to a hospital if you're not already there. You'll then be offered treatment that involves:

oxytocin or another drug called ergometrine, which helps the womb to contract and stop the bleeding

your placenta being removed if it hasn't been delivered already

fluids through a drip

oxygen through a facemask.

If the bleeding continues, you'll be given more oxytocin, ergometrine or other drugs. In some cases, an examination under anaesthesia and surgery and/or a blood transfusion might be needed (NICE, 2017).

Retained placenta and problems after birth

If all or some of your placenta has not come out within one hour of you having your baby, this is called a retained placenta.

If that happens to you, you'll need to be put on an intravenous drip. You might also be offered a vaginal examination to see whether you need an operation to remove the placenta. You'll also be offered pain relief (NICE, 2017).

If you do have the placenta removed under anaesthesia, you'll need to have it done within a few hours of the birth to avoid haemorrhage (Weeks, 2001). You'll then need to be transferred to an obstetric unit if you are not already there and might be advised to have an epidural or spinal anaesthetic when the placenta is actually removed (NICE, 2017).
This page was last reviewed in July 2018.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Important information on the third stage of labour can be found in NICE guidelines.

Begley CM, Gyte GML, Murphy DJ, et al. (2011) Active versus expectant management of women in the third stage of labour. Cochrane Database Syst Rev.(11):CD007412. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007412.pub3... [Accessed: 13th August 2018]

NICE. (2017) Intrapartum care for healthy women and babies. Available from: https://www.nice.org.uk/guidance/cg190/ifp/chapter/delivering-the-placenta [Accessed: 13th August 2018]

RCM. (2013) How to conduct active management of the third stage of labour. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-conduct-active-management-of-the-third-stage-of-labour [Accessed: 13th August 2018]

Weeks AD. (2001) The retained placenta. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704447/] African Health Sciences. 1(1):36-41. [Accessed: 13th August 2018]
Further reading
Begley CM, Gyte GML, Devane D, McGuire W, Weeks A. (2015) Delivering the placenta with active, expectant or mixed management in the third stage of labour. Cochrane Database Syst Rev. 2015.(3):CD007412. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007412.pub3... [Accessed: 13th August 2018]

Jangsten E, Mattsson LA, Lyckestam I, Hellstrom AL, Berg M. (2011) A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial. British J Obst Gynaecol. 118(3):362-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21134105 [Accessed: 13th August 2018]

RCM. (2013) How to promote a physiological third stage of labour. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-promote-a-physiological-third-stage-of-labour [Accessed: 13th August 2018]

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Third stage of labour: delivering the placenta and clamping the umbilical cord

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The third stage of labour is the time between when you have your baby and when the placenta (or afterbirth) comes out (Begley et al, 2011; NICE, 2017). Once your baby's born, the release of the hormone oxytocin will make the uterus contract and become smaller. This'll make the placenta start to separate.

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How the female pelvis works in childbirth

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How the female pelvis works in childbirth

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recap of what we cover in class

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North Surrey Midwife - The wonderful pelvis.wmv

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Women's Health Physiotherapist on Instagram: "Option 2 for perineal massage is to ask your partner to do it for you.
It is awkward to do sometimes on your own, the bump gets in the way, your hands get tired from doing it, it's hard to reach down there!some women just don't have the dexterity to reach down there. I I HEAR YOU! So if you have a partner at home this is where they might be able to lend a hand.. Or two! Sound on. 

As always keeping it real over here.. We've got commentary from the 3 year old, who is probably going to tell people in creche that daddy was rubbing mammys bum and videoing it!! And he would not be wrong

So show your partners and hopefully this video will help!

Also you could use a warm compress before hand (thanks @gentlebirthofficial for that reminder) to help relax and soften the tissues and as always use a little bit of lube. 

Option 3 I will show in my next post which is in standing and personally what I found the easiest

#cantbelieveheagreedtothis #socialservicesgivemeabreak #lockdown3ivegonemad #perinealmassage #pregnancy #partnermasage #partnerperinealmassage #thephysiogirl"

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265 likes, 70 comments - thephysiogirl.ie on January 8, 2021: "Option 2 for perineal massage is to ask your partner to do it for you.
It is awkward to do someti..."

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Good article on this from Baby centre

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by , Senior Midwife and Team Leader July, 2019

Your perineum is the area between your vagina and your bottom. Massaging this area during pregnancy (perineal massage) can help to prepare your body for giving birth, by loosening the muscles that need to stretch as your baby emerges into the world.

If you've never given birth vaginally before, massaging your perineum towards the end of your pregnancy can reduce your risk of episiotomy. It may also reduce your risk of tearing. Even if you have had a baby before, perineal massage can help to reduce discomfort in the months after the birth.

Perineal massage should focus on the inside of your vagina, though you may still feel the skin on the outside stretching.

Here's how to do perineal massage in pregnancy:

Make sure that your hands are clean. You may find the massage more comfortable if your nails aren't too long.

Choose a comfortable position. This could be sitting or lying down, or you could try standing with one foot on a chair. You could even try doing the massage in the bath or shower (or just afterwards), where the warm water will help to soften your perineum.

Put some oil on your fingers and thumbs, and around your perineum and the entrance to your vagina. Good oils for perineal massage include vitamin E oil, coconut oil, sunflower oil and grapeseed oil.

Place your thumbs inside your vagina. Press them firmly towards your perineum and against the sides of your vagina until you feel a tingling or stretching sensation.

Firmly massage in a U-shaped motion. Move from the sides of your vagina downwards to your perineum, and back up again. To start with, aim to do this for about a minute. But with practice, you may be able to continue the massage for up to five minutes.

Start perineal massage when you're about 34 weeks pregnant and aim to do it at least once or twice a week. Doing it more often than this may not decrease your risk of episiotomy or tear any further. But it could lessen the pain you have in your perineum in the months after your baby's born, so there's no harm in doing it more often if you want to.
The important thing is to find a routine that works for you, and stick to it. Perineal massage shouldn't hurt, though it may feel quite uncomfortable, particularly at first. If you are finding it painful, especially after you've been doing it for a few weeks, your GP or midwife can help to check your technique.

When you're heavily pregnant, it can be difficult to do perineal massage yourself. If your partner is willing, he can do it for you. The process is the same, although he may find it easier to use his fingers, rather than his thumbs.

After you've been doing perineal massage for a few weeks, you may notice the skin and muscles around your vaginal opening becoming looser. This is a great sign that the massage is working.

It's safe to massage your perineum if you have a scar from a previous birth. But if you have a vaginal infection such as thrush, or any unexplained discharge, check with your GP or midwife before trying it.

Massaging your perineum isn't the only way to prepare your body for giving birth. Find out why it's also important to keep up with your pelvic floor exercises and get tips on other ways to reduce your risk of episiotomy.

Polly Logan-Banks is an experienced editor with a keen interest in producing evidence-based content. Polly is passionate about ensuring that every child gets the best start in life.

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What is perineal massage and how is it done?

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by , Senior Midwife and Team Leader July, 2019 Your perineum is the area between your vagina and your bottom. Massaging this area during pregnancy (perineal massage) can help to prepare your body for giving birth, by loosening the muscles that need to stretch as your baby emerges into the world.

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This may help to get baby into a helpful position for birth. The evidence is contradictory as to exactly how helpful. Sorry I can't seem to upload it the right way up!