Routine actions in the third stage

In most hospital units, the third stage is ‘actively managed’, which may speed up this stage of labour. However, you may choose a physiological, ‘unaided’ third stage.

Physiological third stage

An unaided or physiological third stage happens without an injection or cord traction and can take longer than an ‘actively managed’ third stage. The action of breastfeeding your baby, or simply having her lie on your chest with skin-to-skin contact, stimulates the release of the hormone oxytocin. This helps your uterus to contract and push out the placenta and the membranes. The cord is cut when it stops pulsating, often after the placenta is delivered.

You may want to discuss the third stage and whether it is actively managed or not when making your birth plan. If you have problems in the first or second stages of your labour (or with a previous birth) then a physiological third stage may not be a safe option. Discuss this with your midwife.

Complications

Sometimes complications can occur:

  • Occasionally, the placenta does not detach from the uterus. When this happens, the mother needs a small operation (under anaesthetic) to remove it.
  • Sometimes women will bleed severely during the third stage. This is called postpartum haemorrhage or PPH and needs to be treated immediately.

Routine ‘actively managed’ third stage

  • You may have an injection to cause the uterus to contract or shrink. This is given when the baby is being born, usually when the first shoulder is coming out. The injection will go into your thigh or buttock and the midwife will ask your permission first.
  • Once your baby is born, the umbilical cord is clamped and cut.  Depending on circumstances, delaying cord clamping may be encouraged. 
  • As the injection takes effect, it stimulates the uterus into contracting, causing the placenta to detach. At this stage, you may be able to push the placenta out. More usually, the midwife will help deliver it by putting a hand on your tummy to protect the uterus and keeping the cord taut (this is called ‘cord traction’).
  • The placenta comes away and the blood vessels that were ‘holding on’ to it close off as the muscle in your uterus contracts. This prevents bleeding – although it’s normal to bleed a little. You may feel the placenta slide down and out between your legs, followed by the membranes.

After the birth

You may hardly be aware of the third stage, as you will be focused on your baby. Seeing and handling your baby, and offering her your breast will stimulate hormones that help the placenta to separate. You may feel shaky due to adrenaline and the adjustments your body immediately starts to make, or you may simply be on a high. You may find it hard to pay attention to the baby if you have had a long labour. There’s nothing wrong with your maternal instincts; you are simply exhausted. If this happens to you, take your time. After a rest you will be much more interested in getting to know your baby. A lot of women are very hungry and ready for tea and toast, while others want to telephone everyone and tell them the wonderful news!

Admire your new baby. Count her fingers and toes. Hold her close to your body, preferably skin to skin. Rest together in skin to skin contact. Baby may start to show signs that she wants to feed and you can then offer your breast. If you’re going to breastfeed, offer your breast as soon as possible; your midwife will help you. Don’t worry if your baby doesn’t seem very interested. Even if she’s only touching and nuzzling you, this will help her to get going with breastfeeding.

If you are unsure of whether you want to breastfeed, then decide to give it a try. You can always stop later if it is not for you, and then your baby will have received some of the benefits of breastfeeding. Starting breastfeeding later on, is much more difficult.

Stitches

Small tears and grazes are often left to heal without stitches because they often heal better this way. If you need stitches or other treatments, it should be possible to continue cuddling your baby. Your midwife will help with this as much as they can.

If you have had a large tear or an episiotomy, you will probably need stitches. If you have already had an epidural, it can be topped up. If you haven’t, you should be offered a local anaesthetic injection.

The midwife or maternity support worker will help you to wash and freshen up before leaving the labour ward to go home or to the postnatal area.

Post-partum haemorrhage

Post-partum haemorrhage (PPH) is a complication that can occur during the third stage of labour, after a baby is born. PPH is extremely rare in the UK. 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 six weeks afterwards.

There are two types of PPH, depending on when the bleeding takes place:

  • primary or immediate – bleeding that occurs within 24 hours of the baby’s birth
  • secondary or delayed – bleeding that occurs after the first 24 hours, up to six weeks after the birth

Depending on the type of PPH, the causes include:

  • contractions stopping after the baby is born (uterine atony)
  • part of the placenta being left in the womb (known as ‘retained placenta’ or ‘retained products of conception’)
  • infection of the membrane lining the womb (endometritis)

To help prevent PPH, you will be offered an injection of Syntocinon as your baby is being born, which stimulates contractions and helps to push the placenta out.

Last Updated: 06 March 2017
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