The third stage of labor is the period between the birth of your baby and the delivery of the placenta. It’s the shortest stage, lasting a median of about 6 minutes, though it can take up to 30 minutes or longer. While most of the hard work is done by this point, this stage matters because it’s when your body separates and expels the organ that sustained your baby throughout pregnancy, and how it goes determines your risk of heavy bleeding afterward.
How the Placenta Separates
Once your baby is born, your uterus continues to contract. These contractions serve a different purpose now: they shrink the uterine wall, creating a shearing force between the elastic muscle tissue and the more rigid placenta still attached to it. Think of it like peeling a sticker off a balloon as the balloon deflates. The separation usually starts at one edge, most often the lower pole, and gradually spreads across the entire attachment site.
This process works because uterine muscle has a unique property: after each contraction, it stays shorter rather than relaxing back to its original length. Each successive contraction reduces the surface area of the spot where the placenta is attached, progressively loosening it. Small blood vessels in the placental bed also rupture during this process, forming a thin layer of blood behind the placenta that helps push it away from the uterine wall.
Once fully detached, the placenta slides down into the lower uterus and vagina, where it’s delivered with a push or gentle guidance from your care provider.
What It Feels Like
Contractions typically resume about 5 to 30 minutes after your baby is born. They’re generally milder than the contractions you experienced during active labor, though they can still feel like strong cramping or pressure. You may be asked to push once more to help move the placenta out, or your provider may press on your abdomen to guide it forward. There’s usually a gush of vaginal bleeding as the placenta separates and delivers.
Some women barely notice this stage because they’re focused on their newborn. Others feel shaky, chilled, or feverish in the minutes after birth. These sensations are normal and related to the hormonal and physical shifts your body is going through.
Active Management vs. Physiological Delivery
There are two broad approaches to the third stage. In a physiological (or expectant) approach, your body handles the process on its own without intervention, relying on natural contractions and gravity. In active management, your care team takes specific steps to speed things along and reduce the risk of heavy bleeding.
Active management typically involves three components: an injection of a medication that strengthens uterine contractions (given right around the time of birth), clamping and cutting the umbilical cord within the first five minutes, and controlled cord traction, where the provider applies gentle, steady pulling on the cord while supporting the uterus through the abdomen. Uterine massage, where the provider firmly rubs the top of the uterus through your belly, is sometimes added to help the uterus stay contracted afterward.
Current clinical evidence supports the use of medication to prevent postpartum hemorrhage, delayed cord clamping (which benefits the baby by allowing more blood transfer), early skin-to-skin contact, and controlled cord traction when appropriate. Some experts have moved away from bundling these as a single protocol, instead recommending that providers tailor third-stage care to each birth, choosing the interventions that are safest for both mother and baby in that situation.
Why Timing Matters
The third stage gets riskier the longer it takes. A systematic review and meta-analysis found that when this stage lasts 15 minutes or more, the risk of postpartum hemorrhage increases roughly fivefold compared to deliveries where the placenta comes within 15 minutes. At 30 minutes or more, the likelihood of needing a blood transfusion more than triples. At 60 minutes or beyond, the odds of significant bleeding remain elevated at nearly four times the baseline risk.
Even a relatively short delay can matter. One clinical trial found that women who had the placenta manually removed at 15 minutes experienced hemodynamic problems (drops in blood pressure or rapid heart rate) at three times the rate of those who had it removed at 10 minutes.
Retained Placenta
The placenta is considered retained if it hasn’t delivered within 30 minutes during active management or 60 minutes when managed physiologically. This doesn’t always cause immediate heavy bleeding, but hemorrhage can start at any time while the placenta remains inside, and some of that bleeding can be internal and not immediately visible. Your care team will monitor your vital signs closely during this period.
If the placenta doesn’t come on its own, it needs to be removed manually, a procedure done under anesthesia where the provider reaches into the uterus to detach and extract it. Women who have had a previous cesarean delivery face a higher chance of a condition called placenta accreta, where the placenta grows too deeply into the uterine wall, making separation more difficult and sometimes requiring surgical intervention.
What Happens After the Placenta Delivers
Once the placenta is out, your provider inspects it carefully. They check the maternal side to confirm that all the individual lobes (called cotyledons) are present and that none have broken off and remained inside your uterus. They also examine the membranes and blood vessels along the edges. Large vessels extending beyond the placenta’s edge can signal that an extra lobe may have been left behind. Retained fragments, even small ones, can cause infection or continued bleeding in the hours and days after birth.
Meanwhile, your uterus continues contracting to compress the blood vessels at the former placental site. This is the body’s primary mechanism for stopping the bleeding. Your provider will periodically check that your uterus feels firm by pressing on your abdomen, and uterine massage every 15 minutes or so in the early postpartum period helps it stay contracted. You’ll likely feel these checks as uncomfortable pressure, but they’re an important part of making sure the bleeding is under control.