The placenta is a temporary organ that forms within the uterus during pregnancy, serving as the interface between the mother and the developing baby. It provides oxygen and nutrients while filtering out waste products through the umbilical cord. After the baby is born, the delivery of the placenta marks the third and final stage of labor, often called the “afterbirth.” This necessary, medically monitored event typically occurs within minutes of the baby’s arrival.
Signs the Placenta is Ready for Delivery
The process of the placenta detaching from the uterine wall is triggered by strong contractions continuing after the baby’s birth. As the uterus shrinks dramatically, the placental attachment site shears away. Medical staff watch closely for three distinct signs indicating that separation is complete and the placenta is ready to be expelled.
One indicator is a sudden gush or trickle of blood from the vagina, signaling that the placenta has fully detached. Simultaneously, the umbilical cord, which is still attached to the placenta, visibly lengthens outside the vagina.
The third sign is a change in the shape and position of the uterus, which becomes firmer and more globular. As the separated placenta descends, the upper part of the uterus, called the fundus, rises higher in the abdomen. These three physiological changes confirm separation, allowing the provider to assist with delivery.
Management of Placental Delivery
The delivery of the placenta can be managed actively or physiologically, with the active approach being the standard of care in most hospital settings. Active management is a structured approach involving medical intervention to expedite the process and reduce the risk of postpartum hemorrhage.
This management begins with the routine administration of a uterotonic drug, such as oxytocin, immediately after birth. This medication stimulates strong, sustained contractions, helping the placenta detach quickly and minimizing blood loss. Following the onset of these contractions, the healthcare provider typically performs controlled cord traction (CCT).
CCT involves a gentle, downward pull on the umbilical cord while the provider simultaneously applies counter-pressure above the pubic bone to support the contracting uterus. This coordinated action guides the separated placenta out of the birth canal. The combination of medication and physical assistance significantly shortens the third stage, often resulting in delivery within five to ten minutes.
Physiological management, in contrast, involves waiting for the placenta to be expelled naturally through the mother’s own effort, without routine medication or cord traction. This process relies on the body’s natural release of oxytocin, often stimulated by skin-to-skin contact or breastfeeding. The mother may be encouraged to change positions or push, but the process can take up to an hour. Studies show that active management reduces the risk of excessive blood loss by up to 50%.
Immediate Care After Placental Expulsion
Once the placenta is successfully delivered, the immediate focus shifts to preventing excessive bleeding and confirming the completeness of the delivery. The healthcare provider carefully inspects the placenta and membranes to ensure all parts have been expelled. A complete examination is necessary because any retained fragments interfere with the uterus’s ability to contract fully, leading to significant blood loss.
To ensure the uterus remains firm and contracted, fundal check and abdominal massage are initiated. The provider firmly massages the top of the uterus through the abdomen, encouraging muscle fibers to clamp down on the open blood vessels where the placenta was attached. This mechanical stimulation is an effective way to prevent postpartum hemorrhage.
The mother’s vital signs, including blood pressure and heart rate, are closely monitored, along with the amount of vaginal blood loss. Continuous assessment of uterine tone and maternal well-being is maintained for at least the first hour after delivery to stabilize the mother and allow the uterus to begin involution.
When the Placenta Does Not Detach
A retained placenta occurs when the organ fails to deliver within a certain timeframe, typically 30 minutes after birth. This failure is a serious concern because it prevents the uterus from fully contracting, leaving blood vessels open and greatly increasing the risk of postpartum hemorrhage. Retention occurs either because the placenta failed to separate from the uterine wall or because it separated but is trapped inside the uterus by a closed cervix.
If the placenta is retained, prompt medical intervention is necessary to prevent severe blood loss. Initial steps may involve administering additional uterotonic drugs to stimulate stronger contractions. If medication fails, the provider may need to perform a manual removal.
Manual removal involves the physician or midwife inserting a hand into the uterus to detach and extract the placenta. This procedure is performed under appropriate pain relief, often regional anesthesia, to ensure the entire organ is removed. In extremely rare cases where the placenta is deeply and abnormally adhered to the uterine wall (placenta accreta), surgical intervention such as a hysterectomy may be required to stop life-threatening bleeding. Prompt recognition and management of a retained placenta are crucial to maintaining the mother’s health.