Did you know as well as growing a baby whilst pregnant your body is growing a whole extra temporary organ? The placenta delivers oxygen and nutrients to your baby and filters out any waste products. So, once your baby is born you will then need to deliver your placenta as it has done its job! This is called the third stage of labour and this is where your placenta detaches from the uterine wall and is expelled from your vagina.
You will be offered two different ways to deliver your placenta depending on your risk factors. If you are low risk and your pregnancy, labour and delivery have all been straightforward with no complications, then you can deliver your placenta without any drugs or medical interventions. This is called physiological management. Your uterus will continue to contract once the baby has been born, being skin to skin with your baby or starting to breastfeed will help your uterus contract and this will then help the placenta to separate. Once the placenta separates you may have a little gush of blood and you may feel a slight urge to push down again. Keeping upright is helpful as gravity will help bring your placenta down. The duration of this management of the third stage varies between individual women but you can expect your placenta to be delivered within 1 hour after your baby has been born.
The second option for delivering your placenta is active management. This is usually advised and encouraged if you have any risk factors or complications during pregnancy, labour and birth, as these can all increase your chances of having a large blood loss, also known as a postpartum haemorrhage. For active management, you will be given an injection in your thigh of a drug called oxytocin which will encourage your uterus to contract and your placenta to separate. Once your midwife sees signs that your placenta has separated she will pull gently on the cord to encourage the placenta to be delivered. Usually, your placenta will be delivered within 30 minutes with active third stage management.
Your placenta is around the size of a small dinner plate and is being supplied blood by a large network of blood vessels through your uterus wall, therefore once the placenta has separated it leaves a large wound on the inside of your uterus. If there are any signs of excessive blood loss during physiological management then your midwife will strongly advise you to switch to active management and for you to give consent for the oxytocin drug to be administered to control your bleeding. You will also be encouraged to switch to active management if your placenta has not been delivered after 1 hour with physiological management. This is to reduce the risk of a retained placenta and needing a manual removal of your placenta, this would need to be done in theatre by a doctor.
We encourage you to discuss your preferences for third stage management with your midwife during your pregnancy and again with the midwife with you in labour.
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