Informed choice: the third stage of labour

The third stage of labour is the period after the birth of your baby and until you birth your placenta.  In technical terms, it will also continue until all bleeding (if any) is controlled.

A lot of women don’t consider this stage of labour to be important.  You will be surprised by the number of women who have not consider their options, for the third stage of labour, before their birth.

So, what are your choices? 

In your third stage, you can have an ‘actively managed’ third stage or an ‘expectant’ third stage (or sometimes called a ‘natural’ or ‘physiological’ third stage).  Below is a summary of the differences.  In a later article, we discuss thing you should consider in deciding what is right for you.

Actively Managed

The first step in an actively managed third stage involves your midwife injecting an oxytocic drug (eg Syntocinon, Picton, Ergometrine) into your thigh as the baby’s shoulder is being born.  This causes your uterus to contract down onto the placenta in order to expel it more quickly.  This has become normal practice to minimise the risk of heavy bleeding from the uterus (postpartum haemorrhage).

Why? Because it is argued, that it minimises the risk of heavy bleeding from the uterus (postpartum haemorrhage).

The next step happens as soon as the baby is out when its umbilical cord will be clamped and cut.  It is suggested that this is to prevent the baby getting too much blood (hypervolemia) as a result of the strong contractions caused by the synthetic oxytocin(1).

The last step is cord traction.  Cord traction is used to ensure that the placenta is delivered before the cervix begins to close.  The goal is to deliver the placenta within 6 minutes of the birth of your baby!

The risks associated with an actively managed third stage includes:

  • Your baby receiving a reduced amount of blood, which in some cases may cause problems(2);
  • The umbilical cord breaking during controlled cord traction;
  • Some of the placenta remaining in the uterus (retained placenta); and
  • uterine prolapse (where the cord is pulled before the placenta has detached from your uterus).

Please understand that these risks are small and are not listed here to scare you.  As you know, nothing we do in life comes without risks. And it would be unfair to write this article without listing possible risks.

Expectant or physiological third stage

An expectant or physiological third stage involves letting nature take its course.  Once your baby is born, it will be passed straight to you with the umbilical cord still pulsing.

It is recommended that there is minimal immediate intervention.  You get to hold your baby against your chest (skin-to-skin).  Look at, smell, touch and talk to your baby. The more you are in awe of your baby, the more your body will create oxytocin (a naturally produced hormone).  Oxytocin assist your uterus contract down.

If your little one bobs his or her head towards your breast and decides to feed – all the better. When you feel a contraction, you can gently push and with any luck – the placenta is born.  Sometimes you may need to change your position to a standing position or more of a squat and give a few solid pushes.

There is no need for cord traction and no drugs are administered.  As such, it is normal for a physiological third stage to take an hour but can take up to two hours.  Your hospital may have a policy that they will allow you an hour for a physiological third stage before insisting on a synthetic oxytocin injection.

A physiological third stage in itself does not put you at risk of postpartum haemorrhage – it just means there is a time delay on its control should it happen.

To read about things you should consider in deciding which method is right for you, click here.

(1) The risk of rapid transfusion is still widely believed by midwives and is taught in the training of childbirth educators.  However, it is not proven.  And although research conducted with a synthetic analogue of ergonovine found that placental transfusion was accelerated, it did not show the babies receiving too much blood: Yao AC, et al. Placental transfusion rate and uterine contraction. Lancet 1968; 1(7539):380-3. Also, see Sarah J Buckley’s article for a discussion on this.

(2) Usher R, et al. The Blood Volume of the Newborn Infant and Placental Transfusion. Acta Paediatr 1963; 52:497-512

Hi! Natural Birth and Motherhood is about empowering women who are going through the stages of pregnancy, birth, or motherhood.  Find out more useful information on related topics by clicking on the Blog button below.

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