Echoing Suzanne Franklin here, to say that there is almost no reason to
interfere in the essential step in the third stage of labor, of baby coming
to mother's abdomen/chest.  A dead mother, or one who was having an
eclamptic seizure or violently hemorrhaging, or threatening to do grievous
bodily harm to the baby, or simply expressing a strong lack of readiness to
hold baby, would be valid reasons not to in my book.  Mother receiving an
injection of oxytocin, or pushing out the placenta, would not.

Joyce Coleman notes, without condoning it, that some birth attendants use
mother's belly as a 'clean' area to put instruments, and that some keep
mother and baby apart because they want to examine her perineum and make
necessary repairs.  Maybe women are constructed differently there, because
where I work, the perineum can be easily inspected with baby on mother's
abdomen, and in hospital we always have a flat surface available, more
suitable for lining up instruments than a soft postpartum belly.  We find it
much easier to do any needed suturing if mother is preoccupied engaging with
her baby.  When the baby is on mother, I can keep track of it better from my
vantage point between her legs - can see baby's feet nice and pink, and hear
whatever small sounds it is making.  I know as long as the baby is
skin-to-skin with mother, with a blanket or a duvet over them both, the baby
will be just the right temperature too.

Routine injection of oxytocics to expedite delivery of the placenta is a
widespread, evidence based practice, and it has been shown to reduce both
blood loss postpartum and the incidence of serious postpartum hemorrhage.
Most studies are carried out in hospitals where many women are medicated
during labor so their own endogenous hormone secretion may not be at its
best, and staff are used to seeing plenty of blood.  Personally I prefer a
policy of 'expectant management', involving careful observation of mother
until the placenta is delivered, and judicious use of oxytocics at the first
sign of hemorrhage, whether that be before or after the placenta is out.
This is based on my own 'if it ain't broke, don't fix it' attitude in
general.  It is not the policy in the institution where I work - on really
bad days I think we work on the 'if it ain't broke yet, we aren't working
hard enough' principle.

It is my very subjective clinical impression that in those cases where we
'have' to run out with the baby to resuscitate it (we have five labor rooms
and one resuscitating table in a central spot on the ward), mothers
hemorrhage more often.  It is a very serious intervention to separate a
newborn from its mother and I doubt that we know all the repercussions of it
yet.  An institution that practices routine separation, even for 15 minutes
postpartum, has a need to update its policy and procedures to reflect the
current knowledge in the field.

Rachel Myr
midwife, IBCLC
Kristiansand, Norway

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