Birthing the placenta: women’s decisions and experiences

BACKGROUND: Previous research examining the birth of the placenta has focussed on quantitative outcomes comparing active and expectant (physiological) management. However, it is also important to understand women’s experiences of birthing the placenta. METHODS: The participant group consisted of 11 women who had expectant management, eight who had active management and one who was unsure. Participants were interviewed in-depth and the data analysed using thematic analysis. RESULTS: Seven themes were identified in the data relating to before, during and after the birth of the placenta. Before birth themes focused on making decisions and included ‘doing the research’ and ‘natural birth’. During the birth of the placenta themes were ‘boundaries of time’, ‘focusing on baby’ and ‘sensations’. After the birth themes consisted of ‘looking’ and ‘keeping’. CONCLUSION: Most of the women considered a physiological birth of the placenta to be an intrinsic element of natural birth. Active management was considered to be an intervention used if complications occurred. In contrast, women who chose active management did not consider the placenta to be an important element of natural birth, and chose active management in order to prevent complications. Decisions about birthing the placenta were informed by Internet sources and previous personal experiences rather than care providers. During the birth of the placenta care providers managed the boundaries of time whilst women focused on their baby. The sensations women described were consistent across both types of management. Women valued seeing their placenta and having the opportunity to keep it, and placenta encapsulation was popular. The findings of this study contribute the experiences of women to the body of knowledge informing practice during the birth of the placenta.