transverse will often move to a different position, this is not always the case and acesarean birth then becomes necessary. A newborn baby with umbilical cord ready to be clampedThe length of the second stage varies and may be affected by whether a woman has given birth before, the position she is in and mobility. The length of the second stage should beguided by the condition of the fetus and health of the mother. Problems may beencountered at this stage due to reasons such as maternal exhaustion, the front of the baby's head facing forwards instead of backwards (posterior baby), or extremely rarely, because the baby's head does not fit properly into the mother's pelvis (Cephalo-PelvicDisproportion (CPD)). True CPD is typically seen in women with rickets and bonedeforming illnesses or injuries, as well as arbitrary time limits placed on second stage bycaregivers or medical facilities.Immediately after birth, the child undergoes extensive physiological modifications as itacclimates to independent breathing. Several cardiovascular structures start regressingsoon after birth, such as the ductus arteriosus and the foramen ovale. In some cultures, thefather cuts the umbilical cord and the infant is given a lukewarm bath to remove bloodand some of the vernix on its skin before being handed back to its parents.The practice of leaving the umbilical cord to detach naturally is known as a Lotus Birth.The medical condition of the child is assessed with the Apgar score, based on five parameters: heart rate, respiration, muscle tone, skin color, and response to stimuli. Apgar scores are typically assessed at both 1 and 5 minutes after birth.Third stage: placenta
Breastfeeding during and after the third stage
In this stage, the uterus expels the placenta (afterbirth). Breastfeeding the baby will helpto cause this. The mother normally loses less than 500 mL (2 cups, or 1 pint) of blood.The placenta should never be pulled from the mother by an untrained person; this couldcause it to tear and not be expelled whole. It is essential that the placenta be examined toensure that it was expelled whole. Remaining parts can cause postpartum bleeding or infection.The alternative to natural delivery of the placenta is what is called Active Management:this involves administration of a prophylactic oxytocic before delivery of the placenta,and usually early cord clamping and cutting, and controlled cord traction of the umbilicalcord.A Cochrane database study suggests strongly that blood loss and the risk of postpartum bleeding will be reduced in women offered active management of the thirdstage of labour. However, the group treated with active third phase management, therewas an increased risk of unpleasant side effects (eg nausea and vomiting), andhypertension. The authors suggest that this is due to the use of ergometrine as acomponent of the oxytocic. No advantages or disadvantages were apparent for the baby.Details of CCT are available. This procedure must not be attempted except byappropriately trained providers.