17 Jul, 2019

Stages of Labour: The Placenta – what, when, where, how?

Once your baby is born, you will hopefully feel a sudden sense of relief, that it is all over and you can start your journey parenting your baby. Labour isn’t finished yet, you are now entering the third stage of labour – the part where your placenta is born.


The third stage of labour begins right after you have given birth to your baby and ends once your placenta has been birthed.
Do not forget that you are still in labour at this vital time. As much as the ‘important’ part is done, the part you have been longing for, for months, getting the placenta out is still very necessary. I’m going to rewind a bit, just in case people don’t know what a placenta is. A placenta is the organ which provides nutrients to your baby, it helps your baby grow and sustains them for the entire pregnancy. It is attached to the inside of your uterus (womb). The umbilical cord comes out of the placenta and into your baby.
Once your baby has been born, they will be passed onto your chest and the umbilical cord will be coming out of your vagina; the placenta remains inside of you at this point and will stay there for varying amounts of time, depending on how you are planning on birthing your placenta.


You enter the third stage of labour as soon as your baby has been born. The length of this stage will vary, just like every other aspect of labour! In general though, it will last up to an hour in most women, generally quicker than this, depending
on the method you choose to birth your placenta (I will come onto this in a moment).


You will stay exactly where you have given birth to your baby, to birth your placenta (unless there are any complications which occur)
If you are in the birthing pool, it may be recommended that you come back onto dry land for this stage, although this will depend on your midwife and local guidelines. The majority of women will birth their placenta on the bed, some standing up, some on the toilet! It
is just like childbirth itself – you can be where you feel most comfortable.


Once you have given birth to your baby, your uterus will continue to have surges (contractions). Lets do some imagining again… your placenta is attached to the inside of your uterus and is being supplied constantly by your blood vessels. The placenta will slowly begin to detach from the wall and these blood vessels are left to run wild! They will continue to supply blood, but the placenta is now gone. This is why it is essential that you continue to have surges – to cut off the blood supply, so you do not have a heavy bleed. The body is specially designed to birth the placenta, but you must again remember that you are still in labour, you still need oxytocin to ensure you have your surges, so you should remain as relaxed and calm as possible.

Your baby will be on your chest at this point, provided all is well. The umbilical cord will be left to return all the blood that it contains, to your baby. Did you know that 1/3 of your baby’s blood supply is left in the cord immediately after birth?! This is why the cord is generally not clamped until it turns white #waitforwhite #optimalcordclamping

You now have two options for birthing your placenta:

1. Physiological third stage – in other words, you let it come out without any intervention. This would be recommended if you have had a straight forward labour, with little intervention
Depending on local guidelines, approximately 1 hour is a widely accepted time for birthing your placenta this way, although it will vary
The cord may remain attached to both the placenta and the baby during this time if you wish. You will be encouraged to remain active, empty your bladder and keep yourself relaxed. Breastfeeding can support the production of oxytocin.
This method is used mostly in midwifery led units or at homebirths

Here I will quote the NICE guidelines on the third stage of labour:

Physiological Management is associated with:
Nausea and vomiting in about 50 in 1000 women
An approximate chance of 29 in 1000 of a haemorrhage (bleed) of more than 1 litre
An approximate chance of 40 in 1000 of a blood transfusion

2. Active third stage – you will be given an injection of oxytocin into your leg
This would be recommended if you have a higher chance of bleeding, either based on your medical history, or the labour itself. It can also be chosen as a preference. An active third stage is currently the default for many hospitals
It usually takes up to 30 minutes, according to national guidance, to birth your placenta
using this method
The cord will be cut and injection adminstered
Your midwife will place her hand on your abdomen and gently pull on the umbilical cord, to help your placenta to be born

NICE guidelines state:

Active management:
Shortens the third stage compared with physiological management
Is associated with nausea and vomiting in about 100 in 1000 women
Is associated with an approximate chance of 13 in 1000 of haemorrhage (bleed) of more than 1
Is associated with an approximate chance of 14 in 1000 of a blood transfusion

There is also some evidence that states the use of synthetic oxytocin can increase the likelihood of postnatal depression.

NICE Guidelines:

I would recommend reading Sara Wickham’s book Birthing Your Placenta:


Please ensure that you arm yourself with knowledge and information about how you may wish
to birth your placenta. This will help you to make an informed decision when the day comes. If
you would like to learn more about this topic, it is covered on all of our hypnobirthing courses.
Get in touch to find your local instructor!

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