Most people don't give a thought to birthing their placenta - they are so much more focussed on the main event, and may wonder if it's worth talking about at all!
What is the Third Stage of Labour?
The third stage of labour starts when your baby is born, and ends after you birth your placenta. This can take anywhere from 5 minutes to an hour, or sometimes more. The placenta is a soft organ which is responsible for supplying your baby with all the nutrients they need to survive. It also produces many of the pregnancy hormones which help your body adapt to the changes required.
Physiological Third Stage
During the pushing stage of labour, as your baby is squeezed through the birth canal, about 1/3 of their blood is pushed back into the placenta. After the birth, this freshly oxygenated blood rushes back into their body, over 5-10 minutes, giving them ample time to work out how to breathe by themselves. (this is why babies can be born safely into water!)
Most people chose to cut the cord once it has turned white (showing all the blood has been transferred to baby) but some people prefer to wait until the placenta has been born. You may hear the term 'delayed cord clamping' this is because of the current medical intervention to cut the cord very quickly while blood is being transferred.
As your placenta detaches from the lining of your uterus, usually 20-60 minutes after your baby is born, there will be blood loss. This is completely normal, your blood volume increased during pregnancy so you have some spare to get rid of now!
While you cuddle your baby and fall head over heels in love, the surge of oxytocin (hormone of love AND contractions) takes effect on your uterus once more and you will experience some mild contractions and birth the placenta. As your uterus shrinks in size, the blood loss is slowed and you will continue to cuddle your baby enabling the magical hour to take effect and increase the ease at which breastfeeding and your bond is established.
- Babies have better iron stores, for up to 6 months after birth which is linked to better brain development and higher IQ.
- Higher breastfeeding success rates
- Mums report a higher rate of satisfaction with their experience
- Typically mums have less blood loss after the birth (as they loose most of the additional blood during this stage)
- A small number of women may loose too much blood (over 500mls = Post Partum Haemorrhage, PPH) and historically there was no treatment for this, making this the riskiest part of the birth.
If this does happen, there are always drugs on hand to treat quickly and effectively whether at home or hospital.
It is thought that when the third stage is disturbed (i.e. bright lights, loud voices, strangers and baby being taken away) the Mother will not produce enough her own oxytocin, making a PPH more likely
Active Management and the Syntocinon Injection
Syntocinon is the synthetic form of Oxytocin. It has a very strong effect on the body i.e. creating very strong uterine contractions, however it does not interact with your brain, or other hormones - except to reduce the production of your body's natural oxytocin.
When this was first introduced in the 1950's it was hailed as a wonder drug, and was soon being used in every single birth as a preventative measure. This still continues to present day unless a woman says otherwise and this is how an actively managed birth usually happens...
- As baby's shoulder emerges a midwife injects the drug, usually into a woman's thigh (she doesn't usually feel it due to the intensity of birth). The woman is helped onto her back if she isn't already, as the midwives anticipate the next stage.
- The cord must be cut very quickly to stop the drug passing through to baby- guidelines now advise waiting 2-3 minutes.
- Mother will experience strong, often painful contractions as the drug takes effect.
- Midwives will massage the woman's belly and tug on the cord. The placenta must be removed quickly before the opening of the uterus clamps down.
- Baby is taken to be weighed, measured, and sometimes swaddled before being passed back.
- Midwives can then leave the room and move on to their next task.
- There is an overall reduction in blood loss during the third stage, however blood loss during the following 6 weeks is increased as the mothers blood volume returns to normal.
- Some women may perceive that it is better to have this bit over with very quickly.
- Nausea, sickness and headaches and shaking are common side effects.
- Retained placenta (resulting in manual removal in theatre)
- Reduced breastfeeding success
- Interrupted magical hour and instinctive behaviours in both mother and baby.
- Mothers confidence in her ability to care for her own baby is undermined.
Sometimes if birth has been more complicated, if labour has been sped up or induced, or forceps or ventouse were used to help your baby be born then you are at a much higher risk of PPH and you will be strongly advised to opt for Active Management of the Third Stage.
However we do know of women who have achieved delayed cord clamping after a caesarean birth, and after a previous PPH. As with any aspect of birth - you make the decisions, and you know what is best for you and your baby.
Emma's Antenatal offers practical and emotional support in all areas of pregnancy birth, and early parenthood: 07922505272. We also offer antenatal courses and pregnancy yoga which are a great way to find out more about labour, birth and life with a new baby.
Dads and Mums who are birth partners might find our Birthing4Blokes page useful
There is useful information in the NICE guidance on Care in Labour
NHS Choices also provides a Guide to Labour.
The Homebirth Reference site discusses Post Partum Haemorrhage in more detail along with some great birth stories.