Your placenta

The third stage of labour is the time between when your baby has been born and the birth of the placenta. Your womb will continue to contract and will be reducing in size. As your womb becomes smaller the placenta will comes away from the side of the uterus and move down into your vagina. As this happens you will have some blood loss as the blood vessels that were connecting the placenta and the uterus will temporarily bleed. The blood loss reduces once the blood vessels constrict and close up the space where your placenta was attached.

Physiological third stage

This is when you allow your placenta to be birthed without any intervention. By having baby skin to skin or feeding this helps oxytocin (the love hormone) to be released, which in turn contracts your womb and encourages it to come away from the wall of the uterus and be delivered. It is important that the environment is also optimal for releasing oxytocin – you should feel safe and undisturbed.  There is no need for the midwife to do anything except quietly observe your blood loss.  It may be beneficial to be in an upright position at this time and empty your bladder to aid the process. If there are any concerns about your blood loss your midwife will let you know and will then recommend active management. The birth of your placenta this way can take any time up to an hour to be birthed.  It may be recommended to convert to active management if it takes longer than this. 

Active management of third stage

This is when an injection of oxytocin is given into the top of your leg once baby has been born.  There is no need to cut baby’s cord before this is done.  The medication is designed to help contract your uterus to encourage the delivery of the placenta and to minimise blood loss.  The midwife will then keep one hand on your abdomen to guard the uterus and then gently pull the cord to deliver the placenta.  Active management is recommended if you have had an induction of labour. This is because your contractions during labour were induced and it is safer to continue on the course of intervention as the risk of haemorrhage is greater after an induction of labour.  Possible side effects of the injection are nausea/vomiting and an increase in your blood pressure.

Situations when active management will be recommended:

• If you haemoglobin level is low prior to birth
• If your BMI is greater than 35mg/m2
• If you have had  4 or more babies before
• If you have experienced bleeding during pregnancy
• If you have a blood disorder
• If you have had excess amniotic fluid in pregnancy
• If you have a bicornuate uterus
• If you have uterine fibroids
• If you are older than 35 years old
• If you have undergone induction of labour
• If oxytocin has been used to speed up labour
• If you have had a long first or second stage of labour
• If you have had a very fast labour
• If you have had an instrumental birth
• If you have had a caesarean section
• If you have had a previous postpartum haemorrhage