Managing the third stage of labour

Management of the third stage of labour and your options

Whilst you may have delivered your baby in the second stage of labour, there’s still a lot happening as you enter the third stage of labour. In this blog, we’ll talk about what the third stage is, what happens during this time, how long it will last and how it will be managed by your midwife and birthing team.

What is the third stage of labour

There are three stages of labour. The first is when your cervix opens, the second is when you birth the baby and the third stage of labour occurs after your baby has been born. It is the full delivery of the placenta. Understanding the different stages can prepare you for giving birth. You’ll know what to expect and how things will be handled by your midwife.

How will the third stage of labour be managed?

There are two main ways that the third stage of labour will be managed. These are active management and physiological management.

Physiological management in the third stage

Generally speaking, physiological management is offered to you as a choice in certain circumstances. Following a discussion of the risks and benefits with you by your midwife, you can make an informed decision. There are occasions when physiological management is not recommended, but again this will be discussed with you. After you’ve delivered your baby, your body releases the hormone oxytocin which makes the uterus contract. This helps the placenta separate and move through the birthing canal.

Midwives will use this natural process, along with gravity, contractions and your body’s ability to push to help the placenta come out. To enable this, they may ask you to sit in an upright position. Skin-to-skin contact with your baby will help your body create more oxytocin, helping to speed up the process.

It could take up to an hour, not normally longer and during this time your midwife will monitor your blood loss. Once the placenta is expelled, the umbilical cord will be cut and clamped.

Physiological management will often be the preferred method, especially if you’re at a lower risk of blood loss. You can move to active management at any point.

It is however largely safe to receive for you and your baby, you will have the opportunity to discuss this option of pain relief with your midwife to enable you to make an informed choice.

    Active management in the third stage of labour

    If you’re at a higher risk of blood loss, your midwife will discuss your options with you to help you make an informed decision and choose the safest option. Active management to help deliver your placenta involves the injection of a drug into your thigh called syntometrine which mimics your body’s release of oxytocin.

    The drug encourages the delivery of the placenta and normally within 30 minutes of having it, the placenta should come out. During that time the midwife will apply a gentle, guarded pressure on your lower abdomen just above your pubic bone (a bone at the top of your pelvis) and gently guide the placenta to deliver by placing gentle traction on the umbilical cord to encourage the placenta to deliver.

    The injection may make you feel sick and vomit but it lowers the risk of heavy blood loss. But it’s not uncommon to feel quite nauseous after you birth your baby.

      What happens if my placenta doesn’t come out?

      If all of your placenta or part of it remains inside the womb, this is known as a retained placenta. Should this happen, a doctor will carry out a vaginal examination and you’ll be placed on an intravenous drip.

      If after a few hours, the placenta hasn’t been expelled, you’ll likely have it removed under a spinal anaesthetic and be under observation at an obstetric ward. It’s really important that all of the placenta is removed. Any particles left in the uterus can lead to complications and infection.

        You deserve to enjoy your labour, birth, and parenthood journey.

        Know what to expect, feel in control, and be heard with our online, midwife-led hypnobirthing course.

        About bitbaby

        While you're here, we'd love to tell you a bit about us.

        A regular pattern of movements is a key indicator of your baby's well-being during pregnancy.

        Women don't always know how to recognise a regular pattern of movements for their baby and don't know what they should be checking for. This leads to increased anxiety. When they do think something isn't quite right, they don't feel confident and they doubt themselves so don't seek advice straight away.

        We're developing a device that will monitor your baby's movements during pregnancy from 24 weeks onwards so that you can have a better understanding of your baby's regular pattern of movements.

        To read more helpful blogs visit our pregnancy blog.

          Help us develop bitbaby

          We are looking for feedback on our device and would love to hear your thoughts. Sign up to get involved.

          Are you currently pregnant?

          By clicking ‘Subscribe’ you agree to Terms & Conditions

          Help us develop bitbaby

          We are looking for feedback on our device and would love to hear your thoughts. Sign up to get involved.