Delivering the placenta: Understanding the Third Stage of Labor

After the baby is born, the placenta still needs to separate from the womb and be delivered. This is called the third stage of labour. Your maternity team continues caring for you during these minutes, including checking bleeding and whether the placenta has come away completely.

Discuss the options before birth

Active management usually includes a medicine to help the womb contract, followed by the clinician helping deliver the placenta once it has separated. Physiological management allows the placenta to come away without routinely giving that medicine, usually with your own effort.

Active management lowers the risk of heavy bleeding after birth. The medicine can have side effects, and your history affects which treatment is suitable. Ask how the balance applies to you and whether any risk factors make a particular approach advisable. You do not need to memorise medicine names or doses to take part in the decision.

Connect the plan with your other preferences

Include the third stage in your birth plan rather than stopping the discussion at the baby’s arrival. Ask who will explain the next steps while you are meeting your baby and whether your companion can help you remember the conversation.

Cord clamping is part of this discussion. Active management does not necessarily mean cutting the cord immediately. The delayed cord clamping guide explains the questions to ask about timing and situations that could change it.

Let the team guide delivery of the placenta

You may feel further contractions or an urge to push. Staff can explain what is happening and what they need you to do. Any controlled pulling on the cord is a clinical procedure performed by a trained professional when appropriate; a companion should not attempt it.

After delivery, the placenta and membranes are checked. The team also assesses your bleeding and general condition. Tell staff if you feel faint, unusually unwell or concerned about the amount of blood, even while attention is on the baby.

Understand why the plan might change

Heavy bleeding needs prompt treatment. If you initially choose physiological management, medicines and further treatment may become necessary because of bleeding or a delay in the placenta coming away. Ask what has changed and what the recommended treatment is intended to do.

A retained placenta sometimes needs removal in theatre with anaesthesia. The team should explain the procedure, pain relief and any additional care needed. This is not a situation to manage by waiting without maternity supervision or trying to remove the placenta yourself.

Ask for an explanation afterwards

If events happen quickly, request a later discussion about the treatment and recovery plan. Ask whether blood loss affects your follow up, medicines or need for additional support at home. Heavy bleeding accompanied by faintness or feeling very unwell after leaving the unit requires emergency help; increasing bleeding or signs of illness also warrant prompt maternity advice.