neonatal transition

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The Beauty of a Natural Third Stage

The ‘third stage of labour’ is described as the time from birth of the baby to the expulsion of the placenta and membranes.

Although succinct, this description does not capture the immense beauty of a natural third stage.


Behold the exquisite moment of first contact between mother and baby in an undisturbed birth

In natural birth, the mother and baby experience peak levels of hormones that create feelings of love, pleasure and alertness during the third stage (oxytocin, endorphins and catecholamines). These natural hormones support a deep bond between the mother and baby and produces strong uterine contractions. These contractions help to separate the placenta from the uterus, expel the placenta and membranes, and control post-partum bleeding.

Observe the vivid colours of a baby transitioning to life outside the womb.

The red and purple of the blood vessels in the the umbilical cord is the transport of oxygenated blood to the baby and deoxygenated back to the placenta. In a physiological birth, the pulsating umbilical cord is left intact while the placenta continues to function. A step-wise shift in blood volume from the placenta to the baby provides an optimal level of oxygen, blood volume and full count of red blood cells, stem cells and immune cells in the baby.

In the minutes after birth, the baby makes the remarkable changes from fetal–placental circulation to independent breathing, circulation and full organ function. The change in the baby’s colour, from ‘white’/ blue/ purple to a reassuring pink, signifies a successful transition from fetal life to life outside the womb.

A natural third stage – sometimes called physiological third stage or ‘expectant’ management – is the culmination of a normal labour and birth with (little to) no intervention.

Parents choosing a natural birth, third stage and physiological cord closure should give due consideration to their chosen birth environment, the impact of interventions, the knowledge and experience of their care providers, and role of other birth attendants.

Along with undisturbed time with the baby, other factors that support a safe natural third stage for the mother include a warm, supportive environment, attention to the mother’s level of comfort, minimal lighting and distraction, delayed or no cord clamping, skin-to-skin contact and the baby initiating breastfeeding.

Thank you to Claire Teague Photography and Skye for granting permission to use this amazing photograph!

Be sure to visit the Claire Teague Photography website and Facebook page

Buckley, S.J. “Leaving Well Enough Alone: Natural Perspectives on the Third Stage of Labor” , Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices (2009) New York: Celestial Arts

Mercer, J. Skovgaard, R. & Erickson-Owens, D. “Fetal to neonatal transition: first, do no harm“, Normal Childbirth: Evidence and Debate second edition (2008) edited by Downe, S. pp149-174

Mercer, J. Skovgaard R. Neonatal transitional physiology: a new paradigm. J Perinat Neonatal Nurs. 2002 Mar;15(4):56-75.

Placenta, cord and baby

About the placenta, cord and baby

- An attached placenta with pulsating cord is a functioning organ.

- The transfer of fetal blood from the placenta to the baby, via the umbilical cord, is part of the physiology and anatomy of birth.

- Placental circulation and transfusion at birth provides the increase in blood volume for the fetal-to-neonatal transition.

- The increase in blood volume is needed for clearing liquid from the lungs, perfusing and expanding the lungs tissue, and catering to the increased organ demands of extrauterine life.

- Placental transfusion provides essential life support during the fetal-to-neonatal transition:

-the perfusion and supply of oxygenated blood supports premature babies, babies born with low oxygen/blood levels at birth (due to cord compression, birth hypoxia, tight nuchal cords etc) and improves the outcomes for babies born via cesarean section .

- The baby receives an infusion of red blood cells, stem cells and immune cells from the placenta (from the placental transfusion):

- the highest number of stem cells circulating our bodies occurs at birth (unless the cord is clamped).

- stem cells have miraculous healing properties and can specialise into multiple types of cells as needed in the body.

- stem cell research is limited - a decision to clamp, collect and store stem cells (harvesting) should consider the risks (known and unknown) of disrupting the birth process and depriving human beings their own stem cells at birth;

- the infusion of blood confers improved red blood cell count and iron stores;

- red blood cells have a critical role in transporting oxygen and carbon dioxide throughout the body;

- the amount of iron stored in the baby’s body from physiological placental transfusion is for making new blood in the first six months of life – low iron can cause infant anaemia (which is associated with cognitive deficits and other health issues).

Mercer, J., Skovgaard, R. & Erickson-Owens, D. “Fetal to neonatal transition: first, do no harm“, Normal Childbirth: Evidence and Debate second edition (2008) edited by Downe, S. pp149-174


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