Birthing the Placenta

This aspect of birth is often left out of the stories (read Think Birth’s article, which includes a water birth video).  When creating a birth plan, it is often the overlooked part of preparations.  Most birth plans focus on contraction management (first stage), some will extend to the birth itself (second stage), but few will continue onto the birth of the placenta.  


Leaving this out of preparation can take a wonderful labour and birth, and turn it into a less than wonderful experience.  The moments of meeting your baby interrupted by the standard protocols of birthing the placenta. (see this peer reviewed article about women’s experiences birthing the placenta)

There are several decision points during this time, which are best considered in advance and communicated to your care providers (including being recorded in your Birth Map).  Your Map may include an ‘if this, then that’ series of decisions based on the lead up to this point.  The following information gives an overview of options during this time, which may be anywhere from a few minutes to a few hours.   This overlaps with meeting your baby and initiating the first breastfeed, which is an important part of the process as breastfeeding and skin-to-skin contact with your baby stimulate contractions.


standard approach to birthing the placenta
This is called ‘Active Management of the Third Stage’.  It involves an injection of synthetic oxytocin in your thigh as the baby’s shoulders emerge or immediately after birth, before the cord is clamped and cut.  The standard practice for clamping is 1 to 5 minutes after birth (be sure to ask your care provider what the standard is in their hospital).  The cord does not need to be clamped or cut at this time, you can specify longer or not at all (also called lotus birth).  See this post for more on ‘delayed cord clamping’.

You may be advised to have a managed third stage if your pregnancy or birth had complications that increase your risk of bleeding heavily. See this Midwife Thinking article for more information

The injection causes your womb to contract strongly which helps the placenta come away and the blood vessels to seal afterwards. You don’t have to push during a managed third stage unless you want to. Once your womb contracts, your midwife will pull (gently) on the cord while pressing on your abdomen above your pelvis.  If you are in a teaching hospital, this may be performed by a student midwife.

A managed third stage usually takes less than 10 minutes.

The Physiological approach (the natural way)
For ‘low risk’ women who have had a labour and birth without intervention, it makes sense to continue with a physiological (natural) third stage.  For some women this may be a few minutes, for others is may be a few hours.  Hospital policies will influence the amount of time ‘allowed’ for this to occur (it could be 30 minutes to an hour, so be sure to ask your care provider).

After your baby is born, your womb will contract and the placenta will peel away from the womb wall. It will then drop down into the lower part of your womb and then your vagina, ready for you to push it out. You may feel pressure or an urge to push as this happens.

If you want to the cord clamped, you will need to specify when, or if (ask what the standard is for your birth location). If  you opt to have the cord clamped, you can also specify who will cut it.  

Once the placenta is born, your care provider will check the placenta and membranes to ensure they are complete and that no part has been left behind.

Read more about The Placenta:Did you know – you can keep you placenta?  What will you do with it?

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