The Three Stages of Labour

The Third Stage of Labour

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For new mums it can sometimes comes as a surprise to learn that there is more to do after they have given birth to their baby. However, the third stage of labour refers to the period between delivering the baby and delivering the placenta. While the thought of more exertion might horrify you, particularly as you have already held the ultimate reward in your arms, don't despair. The third stage of labour is usually quite fast and easy in comparison to what you will have already been through.

What happens during the third stage of labour?

This is where the placenta, the source of all nourishment for your baby through your pregnancy, is delivered. It is attached to the baby via the umbilical cord. Different hospitals have different policies on when to cut the umbilical cord. If you have an injection to deliver the placenta then the cord will be cut early, but if you deliver the placenta naturally then the cord may be left intact until it stops pulsating. It is a good idea to find out what your hospital's general policy on when to cut the umbilical cord is ahead of your labour. This means you will know what to expect.

Should I have the injection to deliver the placenta?

You will be given a choice as to whether or not you should have an injection to help you deliver the placenta, but you should try to discuss this with the midwife before you deliver your baby. The injection is administered into your thigh at the very end of the second stage of labour, usually just after the head and shoulders of the baby are delivered. This technique is sometimes referred to as a "managed" third stage of labour. If you deliver the placenta naturally then it is called a "physiological" or "natural" third stage of labour. It is helpful to be aware of the terminology so that you are not confused when you are in hospital.

The purpose of the injection is to encourage further contractions in order to deliver the placenta and to reduce the amount of bleeding that can happen at this stage. Women who receive the injection usually deliver the placenta in well under 20 minutes, often in as little as 5 minutes. The injection also negates the need for the woman to push. This is because the contraction stimulated by the drugs is usually strong enough to move the placenta down and out of the vagina, with a little assistance from the midwife who may pull gently on the cord.

You may be advised to have the injection if you have had any complications during your pregnancy or delivery such as anaemia, placenta praevia or if you have delivered twins.

Even if you chose not to have the injection then the third stage of labour is likely to be quite fast. During a natural third stage of labour, many women still deliver the placenta in about 20 minutes; however, it can take up to an hour. The midwife may become concerned that too much time is passing between the delivery of the baby and the placenta. In this case, they can give you the injection later to speed up this last part of the delivery. Delivering the placenta naturally may require some pushing on your part but it is usually over with only one or two pushes or contractions. These final contractions are usually encouraged by skin to skin contact with your baby and breastfeeding; if you are happy to try and feed the baby straight away, putting them to your breast will help speed up this stage of labour.

How does it feel to deliver the placenta?

Unlike the baby, the placenta is soft and malleable so it is delivered very easily. In fact, most women report no pain at all - particularly if they are distracted by the fact that they are holding their newborn baby in their arms!

How long does it take to deliver the placenta?

If you have the injection to assist the delivery of the placenta then you can expect to deliver it in a matter of minutes. This time frame can be as little as five minutes, and up to twenty minutes.

During a natural delivery of the placenta, many women still manage it in under twenty minutes, especially if they are able to stimulate contractions by beginning to breastfeed their baby right away. However, in some cases delivery of the placenta can take up to an hour. Your midwife will intervene if they are worried that it is taking too long.

What are the potential complications during the third stage of labour?

Complications are relatively rare during the third stage of labour but the most common one is a condition known as retained placenta. Retained placenta is where all or part of the placenta remains in the uterus. This can cause primary postpartum haemorrhage, or PPH. This is heavy bleeding during the first 24 hours after delivery. If PPH is not detected then it can cause secondary PPH which is where infection occurs. A retained placenta can be treated during the third stage of labour by administering the injection which speeds up delivery, if it has not been given already. Alternatively the placenta, or the remaining membranes can be removed manually. You will be anaesthetised for this. The risks of a retained placenta are higher if you have had it during previous deliveries.

What happens to the placenta after it is delivered?

Your midwife will inspect the placenta to make sure that it is intact, so that they can be confident that you do not have any retained placenta still attached to the lining of your womb. The placenta will then be kept by the hospital and destroyed.

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