Your baby is on your chest, you are shaking with adrenaline, and someone says, “Okay, one more little push.” One more? You were fairly sure you were finished.
That is the placenta, and it is the third stage of labor: minutes rather than hours, and the part nobody covers in the birth class. Two things are worth knowing before the day, one a choice and one simply worth expecting. You usually get a say in how this stage is handled, and this is the stretch of birth where your team watches your bleeding most closely. What follows is what it feels like, how the two approaches compare, and what your team is doing while you meet your baby.
What the placenta is and why it has to come out
The placenta is the organ that fed your baby and handled their oxygen for the whole pregnancy. Once baby is born, its job is over, so your body releases it from the wall of your uterus and you push it out.
This is called the third stage of labor. The first stage was your cervix opening, the second was pushing your baby out, and this last stage wraps everything up. It matters because your uterus needs to be empty to clamp down and slow the bleeding from where the placenta was attached. If your baby arrives by cesarean, your surgeon delivers the placenta as part of the operation, so this stage happens without you doing anything at all.
What it actually feels like
Honestly? Most people barely notice it, especially with a brand new baby on their chest. You may feel a few more contractions, much milder than the ones before, and a small urge to push or some pressure. Your provider might ask you to give one easy push, or gently guide the cord while you do. It is over in a minute or two of effort.
Active versus natural management
There are two common ways to handle this stage, and you can often choose ahead of time.
| Active management | Physiological (natural) | |
|---|---|---|
| What happens | You get a medication (usually oxytocin) and the cord is gently guided | You wait for the placenta to come on its own, often helped by feeding baby |
| Speed | Faster, often within a few minutes | Can take up to 30 to 60 minutes |
| Main benefit | Lowers the risk of heavy bleeding after birth | Fewer interventions if you prefer a hands-off birth |
| Good to know | Often recommended as the safer default | Usually only an option for low-risk births |
Many providers recommend active management because it clearly reduces the risk of postpartum hemorrhage. If you would prefer the natural route, talk it through with your team during pregnancy so they know your wishes. Our labor and birth guide can help you think through the rest of your plan.
What your team does next
- They examine the placenta to make sure it came out complete, with no pieces left behind.
- They check your uterus, often by pressing on your belly, to confirm it is firming up.
- They keep an eye on your bleeding for the next while.
- If you tore or had an episiotomy, any stitches usually happen around now.
If a small piece of placenta is retained, your provider may need to help remove it, since leftover tissue can cause bleeding or infection. This is not common, and your team is watching for it specifically.
Once you are home, the bleeding settles into a pattern of its own over the following weeks, which the postpartum recovery timeline walks through in order.
When to seek care, and when to call 911
Some bleeding and cramping in the days after birth is completely normal. A few things are emergencies. Call 911 or your local emergency number if you have:
- Bleeding that soaks a pad in an hour or less, or that suddenly gets heavier.
- Feeling faint, dizzy, or like your heart is racing.
- A severe headache, or vision changes.
Others need prompt attention rather than an ambulance. Call your provider, or seek urgent care, if you notice any of these.
- Passing large clots, or any clot bigger than a golf ball.
- A fever, chills, or discharge that smells bad.
- Severe belly pain that is not easing.
Medical disclaimer: This article is for general educational purposes only and is not medical advice. It does not replace care from a doctor, midwife, or other qualified professional. Always follow the guidance of your own birth team. If you think you may be experiencing a medical emergency, such as heavy bleeding after birth, contact your local emergency services right away.
Sources
- American College of Obstetricians and Gynecologists. “Postpartum Hemorrhage.” 2024.
- NHS. “What happens straight after the birth.” 2023.
- Cochrane. “Active versus expectant management for women in the third stage of labour.” 2019.
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