Medical Disclaimer: The information in this article is for general informational purposes only and does not constitute medical advice. Discuss the management of the third stage of labour with your midwife as part of your birth plan.
The birth of your baby is, of course, the headline event. But labour does not technically end there. The third stage of labour, which involves delivering the placenta, is a critical phase that every expectant parent should understand. It is usually straightforward and quick, but it requires careful management by your midwife and involves decisions you can make in your birth plan.
What Is the Placenta?
The placenta is an extraordinary organ that you grow specifically for your pregnancy. It forms in the wall of your uterus shortly after conception and acts as a life-support system for your baby throughout pregnancy. It transfers oxygen and nutrients from your blood to your baby and removes waste products. It also produces hormones that maintain the pregnancy and suppress your immune system so your body does not reject the foetus. By term, the placenta weighs approximately 500 to 700 grams.
Once your baby is born, the placenta is no longer needed. Your uterus contracts to separate it from the uterine wall, and it is then delivered through the vagina.
How the Third Stage Works
Active Management of the Third Stage
Active management is the routine approach offered in most UK hospital settings. It involves:
- An injection of a synthetic hormone, syntocinon or syntometrine, into your thigh immediately after your baby is born. This causes the uterus to contract strongly and quickly, detaching the placenta.
- Controlled cord traction: your midwife waits for a sign that the placenta has separated (usually a small gush of blood and the cord lengthening slightly), then applies gentle traction on the cord while supporting the uterus to guide the placenta out.
- The placenta is typically delivered within 5 to 30 minutes of birth.
Active management significantly reduces the risk of postpartum haemorrhage (heavy bleeding after birth) and is the recommended approach for most women giving birth in hospital.
Physiological (Natural) Third Stage
A physiological third stage relies on your body’s own oxytocin release, triggered by holding your baby skin-to-skin and by breastfeeding. No injection is given, and no cord traction is used. You wait for the placenta to separate and deliver naturally, which usually takes 30 to 60 minutes but can take longer.
A physiological third stage is most appropriate in a low-risk, uncomplicated birth, particularly if you have a strong preference for it and are giving birth in a midwife-led unit or at home. The risk of postpartum haemorrhage is slightly higher without active management, which is why your midwife will discuss this carefully with you.
Delayed Cord Clamping
Delayed cord clamping, where the umbilical cord is not cut until it has stopped pulsating (usually 1 to 3 minutes after birth), is now recommended as standard practice by both the NHS and ACOG. Waiting allows up to 80 ml of additional blood, rich in iron and stem cells, to transfer from the placenta to your baby. This is associated with better iron stores and developmental outcomes, particularly for premature babies.
Delayed cord clamping is compatible with active management of the third stage. The syntocinon injection can be given at the time of birth, the cord allowed to pulse for 1 to 3 minutes, and then clamped and cut before active cord traction. The two are not mutually exclusive.
Cord Blood Banking
Some parents choose to collect and bank their baby’s cord blood, which is rich in stem cells. If you are considering this, you will need to arrange it in advance with a private cord blood bank. It must be collected at the time of birth and requires a collection kit to be at your birth. Note that delayed cord clamping and cord blood banking can be difficult to combine fully, as draining the cord for banking reduces the blood that transfers to the baby. Discuss the options with your midwife and cord blood bank.
What Happens If the Placenta Does Not Deliver?
If the placenta has not delivered within 60 minutes of birth (with active management) or longer (with a physiological third stage), this is called a retained placenta. A retained placenta can cause significant bleeding and requires medical intervention. You may be given additional syntocinon via a drip, or if this does not work, you may need to go to theatre for a procedure called manual removal of the placenta, carried out under regional or general anaesthesia. Retained placenta affects around 2 to 3 percent of births.
Inspecting the Placenta
After delivery, your midwife will examine the placenta carefully to ensure it is complete. Any fragments left inside the uterus can cause infection and heavy bleeding. The placenta has a maternal side (where it was attached to the uterine wall, dark red and rough in texture) and a foetal side (smooth, shiny, with the umbilical cord attached at the centre). Many parents are curious to see it, and midwives are usually happy to show you.
What About Lotus Birth or Placentophagy?
Some parents choose to leave the umbilical cord unclamped and uncut until it falls away naturally, a practice called a lotus birth. Major medical organisations including the RCOG advise against this due to the risk of infection. Placentophagy, consuming the placenta (usually in capsule form), is practised by some parents but there is no robust scientific evidence for its purported benefits and some evidence of potential risks. These are choices to discuss openly with your midwife.
Products for the Immediate Postpartum Period
Frequently Asked Questions
Is delivering the placenta painful?
Most women barely notice it. After the intensity of labour, the placenta delivery feels like mild cramping and a pushing sensation. If you had an epidural it is painless. The most uncomfortable part of the third stage for many women is the uterine massage your midwife performs to help the uterus contract and prevent bleeding.
What does a healthy placenta look like?
A healthy placenta is round or oval, dark red to maroon in colour, weighs around 500 to 700 grams, and is complete with no obvious missing fragments. Your midwife will confirm it is intact before recording it in your notes.
Can I keep my placenta?
In most cases, yes. You can request your placenta for burial, encapsulation, or other purposes. Let your birth team know in advance, as there may be paperwork required. Placentas are classified as clinical waste by default, so if you want yours, you need to request it explicitly.
Sources
- NHS. What happens straight after the birth. www.nhs.uk
- RCOG. Postpartum Haemorrhage: Prevention and Management (Green-top Guideline No. 52). www.rcog.org.uk
- WHO. Delayed umbilical cord clamping for improved maternal and infant health. www.who.int
- ACOG. Delayed Umbilical Cord Clamping After Birth. www.acog.org
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