Labor is traditionally divided into three distinct stages. This final stage is a short but important period that determines maternal stability immediately following birth. It focuses on managing the aftermath of delivery to prevent serious complications. The process begins the moment the baby is fully born and concludes with the complete expulsion of the placenta and its attached membranes.
Defining the Third Stage of Labor
The third stage of labor occurs between the birth of the baby and the return of the uterus to a stable, contracted state. It is the shortest of the three stages, typically lasting between five and 30 minutes, though it can extend up to an hour. The purpose of this stage is to safely expel the organ that sustained the pregnancy and to achieve hemostasis, or the control of bleeding, at the site where the organ was attached.
The Primary Event: Placental Separation and Expulsion
The main event during this stage is the separation and expulsion of the placenta from the uterine wall. After delivery, the sudden decrease in the size of the uterus causes the uterine wall to shrink significantly. The placenta, being relatively inelastic, cannot shrink at the same rate, creating a shearing force that causes it to detach from the uterine lining. This separation tears the blood vessels, forming a clot behind the detached placenta. Signs of separation include a sudden gush of blood, a lengthening of the umbilical cord, and the uterus becoming firmer and moving higher in the abdomen.
Clinical Management Strategies
Healthcare providers utilize distinct approaches to manage this stage, primarily to reduce the risk of postpartum hemorrhage (PPH). The most common approach is Active Management, which involves interventions designed to expedite the process. A prophylactic uterotonic drug, such as oxytocin, is administered immediately after birth to promote strong uterine contractions. This is followed by controlled cord traction, where gentle tension is applied to the umbilical cord while counter-pressure is placed on the uterus to guide the placenta out. The alternative is Expectant or Physiological Management, which relies on the mother’s natural uterine contractions and hormonal release, often encouraged by skin-to-skin contact and breastfeeding.
Immediate Post-Delivery Assessment
After the placenta is delivered, assessments are performed to ensure maternal safety and prevent delayed complications. The placenta and membranes are inspected to confirm they are complete, as retained tissue interferes with the uterus’s ability to contract effectively, leading to significant bleeding. The uterus is also assessed frequently by palpating the fundus; it should feel firm and be located near the umbilicus to indicate a well-contracted state. If the uterus is soft or “boggy,” uterine massage is performed to stimulate contractions and prevent atony, the most common cause of PPH. Blood loss is continuously monitored and quantified during this recovery period to quickly identify and manage any excessive bleeding.