Third Stage of Labour
What about the placenta?
The third stage of labour is the timeframe from when your baby is born until the placenta and membranes (an empty bag that held the baby) are delivered. The placenta has done a lot of work during the pregnancy helping your baby get the nutrients they need and take away waste products. As a result of your baby being born, the placenta is no longer needed. The placenta must separate from the uterus wall and exit the vagina following the same path as the baby (don’t worry it is very soft compared to the baby). There are two ways to manage the third stage of labour physiological or active management. At KWMA, a combined method of management is used for clients requesting active management (details below).
With every birth, there is an expected level of blood loss which is normal. The goal of 3rd stage management is to deliver the placenta with the least amount of blood loss possible and to prevent large amounts of bleeding in the postpartum. Some clients will be at a higher risk of bleeding or retained placenta. For these higher-risk clients active management will be recommended by your midwife. Your midwife will discuss with you any risk factors you may have specific to your care.
Physiological Management
No medications or interventions are provided during physiological management. The hormones naturally produced within the body are given time to help the uterus contract separating the placenta from the uterine wall. After the placenta is separated from the uterine wall it, along with the membranes, should be expelled through client effort, with little resistance.
Active Management
Involves three components: the use of uterotonic medications, clamping the cord early, and controlled cord traction to deliver the placenta.
- Uterotonic Medication: 10 IU Oxytocin is injected intramuscularly into the large muscle of the thigh, or through an IV if available (5-10IU).
- Early cord clamping: clamping of the cord at the time the oxytocin is given, with very little delay.
- Controlled cord traction: Where the midwife (or OB) uses gentle traction on the cord still attached to the placenta, to help guide the placenta through the birth canal and out.
Combined Management
As a standard of practice at our clinic, for clients choosing active management, we do not do early cord clamping, unless the baby needs to be moved to the warmer immediately. As standard all midwives at our practice do delayed cord clamping when appropriate (baby is doing well immediately at birth). Therefore, active management at KWMA becomes the administration of 10 IU Oxytocin and the use of controlled cord traction for the delivery of the placenta.
In the last few weeks before the birth of your baby, your midwife will have an informed choice discussion with you regarding the third stage of labour management. If you have questions or requests regarding your third stage of labour please ask your midwife for more details.