one hour as “retained”, under natural conditions (un-induced) this may safely take from 10 minutes to 3 hours. If contractions are absent or ineffectual, gentle abdominal massage can be used to assist.
   The main reason for allowing spontaneous placental delivery is that it is just an integral part of the natural process, and unless there is a real need for intervention then a woman should be given the opportunity to complete her birthing experience in nature’s own time. Natural delivery of the placenta also minimises any after birth pain, bleeding and retained membranes as evidenced by myself and many other women).
   Many natural birthers seem to spend a lot of time and energy focussing on the birth of their baby but remain ignorant about the placenta, thinking it will just take care of itself. Ideally this is true, but in some cases this is where there is trouble. There can surely be nothing more frustrating and disruptive for a natural birther, who is happily holding her new born baby, than to realise she will have to transfer to a labour ward to undergo medical assistance to extract her placenta or part of it.

Problems with Placental Delivery
   Occasionally the placenta does not come away properly (or at all) from the uterus. If the whole placenta does not separate it is called “a retained placenta”. If active management such as syntocin and Controlled Cord Traction fails to correct this, dilation and curette surgery is required to remove it.
   “Retained membranes” is when the placenta is expelled but incompletely, leaving some amount of membranes or tissue attached to the lining of the uterus. Imperfect separation of the placenta can lead to uncontrolled bleeding (post-partum haemorrhage), clots and / or later uterine infection. This can be deduced by an examination of the placenta by the midwife who would note tears and pieces missing. Any midwife observing this will act by using syntocin and abdominal massage to stem the bleeding. However, if there was a large amount of placenta retained, surgery would be required to remove it.
   Most commonly, there is no known medical reason for retained membranes or retained placenta. The tissue just seems to stick to the lining. The 2 most understood causes are: (i) a hypertonic uterus which causes the cervix to close down too quickly after birth, trapping part or all of the placenta inside. This type of reaction is common following syntocin or the other drugs used to speed up placental delivery. (ii) Less common is Placenta Accreta where the membranes

are too deeply attached to the uterine wall and fail to separate. This is caused by scar tissue in the uterus, usually found in those who have had previous uterine surgery such as caesarean section, abortion, dilation and curette or have sustained damage from prolonged episodes of Pelvic Inflammatory Disease.
   To avoid complications in placental delivery a woman should ensure she has the best possible circulation and muscle tone in her pelvis by regular asana practises, particularly the Vajrasana series and backbends. For those with past uterine surgery, time for full healing of the tissue is essential before becoming pregnant again. For those with a history of slow or retained placenta, or poor uterine function in other ways, there are many herbs that can help maximise uterine function. These are best prescribed by a herbalist or naturopath.
 

	~Cutting the Cord~

   Except under emergency circumstances, there is no real need or rush to cut the umbilical cord – regardless of the length of time for placental delivery. Ideally, the cord should have stopped pulsing before cutting it (normally about 3 - 5 minutes, but sometimes as long as 10 minutes), indicating that the placenta has become inactive, that it is beginning to separate from the wall of the uterus, and that the baby has drawn from it the required amount of blood necessary to fill his newly inflated lungs. This requirement is usually observed these days, unless there is some life threatening situation. Also hospitals, in their usual expedient manner, like to get these things done and out of the way and, as a result, their preferred time to do this will be during your moments of first contact and, as previously discussed, that time should be as uninterrupted as possible. The best time to cut the cord is after the placenta has been delivered, when you can be sure that your baby has drawn all the blood from it he needs and that your body has fully given up supporting the baby via your blood. If you want to be sure of relaxed cord cutting in your own time, you can request this on a Birth Plan and again soon after the baby’s arrival. But if the cord is particularly short and would inhibit breastfeed-ing or restrict your ability to move around, then it would need to be tied off and cut close to the baby much sooner.
   Some people feel that the umbilical cord should not be cut at all, and that the placenta and cord should be allowed to wither and fall away naturally over a period of several days. This process is