The placenta is a temporary organ that forms in the uterus during pregnancy, providing oxygen and nutrients to the developing baby and removing waste. It also produces hormones that regulate maternal and fetal physiology. Its expulsion marks the final stage of childbirth.
Understanding the Third Stage of Labor
The “third stage of labor” is the period immediately following the baby’s birth until the complete delivery of the placenta and its membranes. This stage typically lasts five to 30 minutes, though it can extend up to an hour. During this phase, the uterus continues to contract, though less intensely than during the baby’s birth. These contractions help the placenta detach from the uterine wall and be expelled. This phase is important for the birthing person’s health, as it helps control bleeding and ensures the uterus can properly contract and begin its return to a pre-pregnancy size.
Signs of Placental Separation
Recognizing signs of placental detachment is important for a safe and timely delivery. Common indicators include a sudden gush of blood from the vagina, released as blood trapped behind the separating placenta. Another sign is the lengthening of the umbilical cord outside the vagina as the detached placenta descends. The uterus may also change shape, becoming firmer and more globular as it contracts and the placenta moves into the lower uterine segment. Some birthing individuals may also report a feeling of fullness in the vagina, indicating the placenta is ready for expulsion.
Approaches to Placenta Delivery
There are two primary approaches to managing placental delivery: physiological (or expectant) management and active management. Physiological management allows the placenta to deliver naturally, relying on the body’s contractions without medical intervention. This approach typically includes delaying cord clamping until pulsation stops and allowing the birthing person to find positions that aid gravity. The placenta is then expelled spontaneously, often with maternal effort, without immediate cord traction.
Active management is a more interventional approach designed to speed up placental delivery and reduce the risk of excessive bleeding. This method usually involves administering a uterotonic drug, such as oxytocin, immediately after the baby’s birth to stimulate strong uterine contractions. Controlled cord traction, where gentle pulling on the umbilical cord is combined with counter-pressure on the uterus, is often used to assist expulsion. Fundal massage, a gentle rubbing of the uterus, may also be performed after delivery to encourage continued uterine contraction and help prevent hemorrhage. This approach reduces the risk of postpartum hemorrhage.
Immediate Post-Delivery Care
Once the placenta is delivered, immediate care focuses on ensuring the birthing person’s safety. Healthcare providers inspect the placenta to confirm it is complete and no fragments remain, as retained pieces can lead to bleeding or infection. Continued fundal massage is often performed to help the uterus contract firmly, which is crucial for compressing blood vessels at the placental attachment site and preventing hemorrhage. Throughout this period, the birthing person’s vital signs and blood loss are closely monitored.
Addressing Potential Complications
While the third stage of labor is typically uneventful, complications can arise, requiring prompt medical attention. A retained placenta occurs when part or all of the placenta remains inside the uterus after birth. This can happen if uterine contractions are insufficient or if the placenta is abnormally attached. A retained placenta poses a risk of significant blood loss (postpartum hemorrhage) and infection. Medical interventions, such as manual removal, may be necessary.
Postpartum hemorrhage (PPH) is another serious complication, characterized by excessive bleeding after childbirth. It can occur if the uterus does not contract adequately after placental delivery, if there are tears in the birth canal, or if placental tissue is retained. Healthcare providers are vigilant for signs of PPH, including heavy vaginal bleeding, a drop in blood pressure, or an increase in heart rate. Management strategies include uterine massage, administering medications to promote uterine contractions, and, if necessary, identifying and repairing any tears.