The third stage of labour is when your placenta and the bag that held your baby and the amniotic fluid (the membranes) are delivered. You may not know you’re in the third stage (or what’s going on) as you’ll be busy getting to know your baby.
Actively managed or unaided third stage?
In most hospital units, the third stage is 'actively managed' because it is known that women who opt to have this are at less risk of significant blood loss at delivery. However, you may choose a physiological, 'unaided' third stage.
Your midwife can give you more information to help you decide what you’d prefer, and you can put your choice in your birth plan. Your midwife will take your wishes into account.
An actively managed third stage
An actively managed third stage helps to:
- speed up this stage of labour
- reduce your risk of heavy bleeding
During an actively managed third stage:
- you’ll have an injection to reduce the size of your womb
- your midwife will clamp and cut the umbilical cord
- you'll deliver the placenta with or without the help of your midwife
The injection's given when your baby's being born, and usually when their first shoulder's coming out or just afterwards.
Your midwife will ask if it’s okay to give you the injection and then put it into your thigh or buttock. The injection can sometimes make you feel sick.
Clamping and cutting the umbilical cord
Once your baby's born, the umbilical cord will be:
- clamped (pressed together) to stop the blood flowing
- cut between your baby and the placenta
Once your baby is born, the cord won't usually be clamped until it has stopped pulsating, at least a minute. This ensures your baby receives all the blood from your placenta, which is good for your baby's iron levels.
The cord will be cut immediately if:
- it’s wrapped around your baby’s head and needs to be cut
- your baby needs medical help
Your baby will be kept below the level of your abdomen to make sure that all the blood from the cord has flowed through to them.
Delivering the placenta
As the injection starts to work, it makes your womb reduce in size. This helps the placenta to come away.
At this stage, you may be able to push the placenta out. But it’s more likely your midwife will help deliver it by putting a hand on your tummy to protect your womb and keeping the cord pulled tight. This is called cord traction.
Your placenta will come away, and the blood vessels that were holding on to it will close off as your womb gets smaller. This helps to prevent too much bleeding – although it’s normal to bleed a little.
You may feel the placenta slide down and out between your legs.
An unaided (physiological) third stage
An unaided third stage usually takes longer than an actively managed one. You don’t have an injection or cord traction.
Your body releases the hormone oxytocin when:
- you breastfeed your baby
- your baby lies on your chest with skin-to-skin contact
This helps your womb to tighten and push out the placenta and the membranes. Your baby’s cord is cut when it stops pulsing (usually after your placenta's been delivered).
Possible risks of an unaided third stage
Your midwife will weigh up the possible risks of having an unaided third stage if:
- you've had issues in the first or second stages of your labour (or with a previous birth)
- there’s a high chance you might bleed heavily
You can still choose to do this, but your midwife won't be able to recommend it because an actively managed third stage would be safer for you and your baby.
Complications during the third stage
Possible complication of the third stage include:
- primary postpartum haemorrhage (heavy bleeding)
- issues delivering the placenta if it doesn't come away from the womb
Primary postpartum haemorrhage
Post-partum haemorrhage (PPH) is a complication that can occur during the third stage of labour, after a baby is born.
Losing some blood during childbirth is considered normal. PPH is excessive bleeding from the vagina at any time after the baby's birth, up until 6 weeks afterwards.
More about primary postpartum haemorrhage
Assisted delivery of the placenta
Sometimes the placenta doesn’t come away from your womb. If this happens you'll need assistance to have it taken out. This is usually done with an epidural or spinal anaesthetic.
About 1 in 50 women will need this procedure.
If this happened when you had a baby before, it would be one of the reasons why your midwife might suggest you have an actively managed third stage.