Delivery of the Placenta: What to Expect During the Third Stage of Labor

"I just delivered my baby, but I've heard there's still the placenta to deliver. What happens next, and is it painful?"

This question represents one of the most common concerns about the often-overlooked final stage of childbirth. While much attention focuses on contractions and pushing during labor, the third stage of labor (delivery of the placenta) remains a crucial but less discussed part of the birth process.

The placenta, which nourished your baby throughout pregnancy, must be delivered after your baby is born. This relatively short but important phase typically lasts between 5-30 minutes, during which your uterus continues to contract, helping the placenta separate from the uterine wall and be expelled. Understanding this process can help you feel more prepared and less anxious about what to expect during this final stage of childbirth.

The Third Stage of Labor: Understanding Placental Delivery

The third stage of labor begins immediately after your baby's birth and ends with the complete delivery of the placenta. This stage is a natural continuation of the vaginal birth process, but it works differently than the stages that came before.

"Will I need to push again to deliver the placenta?"

Many women wonder about the effort required during placenta delivery. Unlike the intense pushing of the second stage, placental delivery often requires minimal effort. Your uterus does most of the work through continued uterine contractions that help separate and expel the placenta.

Signs that your placenta is separating include:

• A small gush of blood (as the placenta detaches from the uterine wall)

• Lengthening of the umbilical cord outside your body

• A change in the shape of your abdomen as your uterus rises in your abdomen

• Mild cramping sensations as your uterus contracts

"How painful is delivering the placenta compared to delivering my baby?"

Most women find placental delivery significantly less painful than delivering their baby. You'll likely feel mild to moderate uterine contractions, often described as similar to menstrual cramps. These sensations are typically manageable, especially compared to the contractions of active labor.

Active vs. Physiological Management: Understanding Your Options

"I've heard about 'active management' and 'physiological management' for placenta delivery. What's the difference, and which is better?"

This question highlights an important choice you may discuss with your healthcare provider and include in your birth plan before giving birth.

Placenta delivery management approaches differ in their philosophy and intervention level:

"My midwife mentioned something called controlled cord traction. What exactly is that?"

During active management, after signs of placental separation appear, your provider may place one hand on your abdomen to support the uterus while gently pulling on the umbilical cord with the other hand. This technique, called controlled cord traction, helps guide the placenta out in a controlled manner.

The actively managed third stage has become standard practice in many hospitals due to its effectiveness in reducing blood loss and preventing postpartum hemorrhage. However, physiological management may be preferred by those seeking a more natural birth experience with minimal interventions.

Potential Complications and When to Be Concerned

While most placental deliveries occur without issues, understanding potential complications and risk factors helps you recognize when medical attention might be needed.

"What happens if my placenta doesn't come out completely?"

A retained placenta occurs when all or part of the placenta remains in the uterus after 30-60 minutes (timeframes vary by provider). This condition requires medical intervention because it can lead to postpartum hemorrhage - excessive bleeding after birth.

Signs that might indicate a retained placenta include:

• Placenta not delivering within 30-60 minutes after birth

• Heavy bleeding after partial placental delivery

• Continued strong cramping without placental delivery

• Placenta that appears incomplete when examined

"How will I know if I'm bleeding too much after delivering the placenta?"

Some vaginal bleeding is normal after placental delivery, but excessive bleeding can indicate postpartum hemorrhage. Your healthcare team will monitor your bleeding closely, but it's important to alert them if you feel you're soaking through a pad within an hour or passing large clots.

In rare cases, placental complications may be related to conditions like placenta accreta spectrum, where the placenta remains attached abnormally to the uterine wall. These cases require specialized management and may have been identified before giving birth.

Manual Removal and Medical Interventions

"If my placenta doesn't come out on its own, what happens next?"

If you have a retained placenta, your provider may need to perform a manual removal of the placenta. This procedure involves inserting a hand into the birth canal and uterus to separate and remove the placenta. It's typically performed with pain relief or anesthesia.

Other interventions might include:

• Additional medicine called oxytocin or other medications to strengthen uterine contractions

• Ultrasound to locate retained placental tissue

• In rare cases, surgical intervention if other methods aren't successful

"Does everyone who has a retained placenta need surgery?"

No, manual removal is often successful, especially when performed promptly. Surgical intervention is generally reserved for cases where other methods have failed or for treating complications like uterine inversion, a rare but serious condition.

The Emotional Experience of Placental Delivery

The third stage of labor comes with its own emotional landscape. After the intensity and joy of meeting your baby, placental delivery might feel like an afterthought, or it might bring a sense of completion and relief.

"Can I hold my baby while delivering the placenta?"

In most cases, yes. Unless there are complications requiring immediate attention, skin to skin contact with your baby can continue during placental delivery. In fact, the oxytocin released during this bonding time can help your uterus contract effectively for placental delivery.

Many parents don't remember much about placental delivery because they're focused on their newborn. This is perfectly normal and doesn't diminish the importance of this stage.

Having your birth partner present during this time can provide additional support, especially if complications arise that require your attention to shift temporarily from your baby.

After Placental Delivery: What Happens Next

Once your placenta is delivered, your provider will likely:

• Examine the placenta to ensure it's complete (including the fetal membranes)

• Check your uterus to make sure it's firm

• Repair any tears or episiotomy if needed

• Monitor your blood loss

• Help you begin breastfeeding if desired (which helps the uterus contract)

"What happens to the placenta after it's delivered?"

Hospital practices typically involve examining the placenta and then disposing of it according to medical waste protocols. However, if you have specific cultural practices or preferences regarding your placenta, discuss these with your healthcare provider before birth.

Making Informed Choices About Third Stage Management

"How do I decide between active and physiological management for my placenta delivery?"

This decision is ideally made before labor begins, as part of your birth preferences discussion with your provider. Consider your health history, risk factors for bleeding, and personal preferences when making this choice.

Remember that circumstances during birth might necessitate adjusting your plans. For example, if labor has been particularly long or complicated, your provider might recommend active management to reduce bleeding risk, even if you originally preferred physiological management.

Delayed cord clamping has become increasingly common even within active management approaches, as research shows benefits for the baby regardless of the method chosen for placental delivery.

The delivery of the placenta represents the final phase of your childbirth journey. While briefer and generally less intense than earlier stages, it's an important transition as your body begins its recovery and you embark on your postpartum journey with your new baby.

This article provides general information and should not replace medical advice. Always consult your healthcare provider about your specific situation and options during childbirth.