How do I want to deliver my placenta?
The third stage of labour is when the placenta and amniotic membranes (the protective bag of fluid surrounding your baby) are delivered. You will be busy getting to know your baby so may not realise this final stage of labour has begun. There are two ways this stage of labour can be managed:
Physiological management of the third stage (unaided)
This is when you birth your placenta without the use of any medications. You will experience some mild contractions that start following the birth of your baby which help to deliver your placenta. Your placenta should be delivered within 60 minutes. You will not have an injection to help deliver your placenta, but your midwife may make suggestions about how to help with the third stage of labour.
To help birth your placenta, your body needs to release oxytocin. Skin to skin contact and breastfeeding can help this process, so your midwife may suggest trying these. It can also help to make sure you have an empty bladder; therefore, you may be asked to try and pass urine if there are no signs of the placenta being born. Mobilising or squatting can also be effective, using the aid of gravity to help.
Benefits: No injection; no side effects from any medication; you can choose to change to active management if there are no signs of the placenta being born.
Risks: There are some risks associated with a physiological third stage and it may not be recommended for everyone. There is a slightly higher risk of heavy bleeding following delivery of the placenta, particularly if you have had any prior issues during labour or in a previous birth.
Active management of the third stage (injection to help birth placenta)
This is when you are given an injection of artificial oxytocin (syntocinon), or oxytocin mixed with ergometrine (syntometrine) into your thigh immediately following the birth of your baby. This stimulates the uterus to contract more quickly, expelling the placenta and lowering your risk of heavy bleeding. Your midwife will watch carefully for signs of separation and help to deliver your placenta using ‘controlled cord traction’. This will involve the midwife placing their hand on your tummy to protect your womb and keep the cord pulled tight until it delivers. This usually takes less than 30 minutes.
Benefits: Reduced risk of heavy bleeding after birth; can take less time than physiological management of the third stage.
Risks: Sometimes the injection can give you a headache or make you feel nauseous, although this usually passes without actual vomiting.
Do I want to keep my placenta?
Your placenta and amniotic membranes will be checked to make sure they are complete. They are usually then disposed of at the hospital. If you would like to keep your placenta, you must discuss this with your midwife and arrange for it to be safely stored and/or transported following birth yourself.
