The third stage of labor is the phase following the baby’s birth, involving the delivery of the placenta and its associated membranes. This stage is important for maternal well-being, as complications can impact the birthing person’s health. While often the shortest, its proper management is important for a safe outcome.
The Placental Delivery Process
After the baby’s birth, the uterus continues to contract to facilitate placental separation and expulsion. These contractions cause uterine muscle fibers to shorten and thicken, creating a shearing force that detaches the placenta from the uterine wall. As the placenta detaches, exposed blood vessels lead to some bleeding. A retroplacental clot often forms behind the separating placenta, aiding its detachment.
The detachment process can occur in two main ways: the Schultze method, where separation begins centrally, or the Matthew’s Duncan method, where it starts at the margins. Once fully detached, the placenta descends into the lower uterus and then into the vagina. The birthing person may experience mild contractions or pressure as the placenta moves through the birth canal.
Signs that the placenta has separated and is ready for expulsion include a gush of blood from the vagina, a sudden lengthening of the umbilical cord, and a change in the uterus’s shape, which becomes firmer and more globular. Spontaneous expulsion typically occurs within 30 minutes of the baby’s birth. If this process extends beyond 30 minutes, the risk of complications, particularly postpartum hemorrhage, increases.
Approaches to Third Stage Management
Two primary medical approaches guide third stage labor management: Active Management of Third Stage Labor (AMTSL) and Expectant Management, also known as physiological management. Each approach involves distinct practices.
Active Management of Third Stage Labor (AMTSL) is a proactive approach designed to expedite placental delivery and reduce excessive bleeding. This involves administering a uterotonic medication, such as oxytocin, immediately after the baby’s birth. This medication promotes strong uterine contractions, helping to detach and expel the placenta quickly. AMTSL also includes controlled cord traction, where the healthcare provider gently pulls on the umbilical cord while applying counter-pressure to the uterus to guide the placenta out. Uterine massage after placental delivery is another component, further encouraging uterine contraction and minimizing blood loss. The aim of AMTSL is to prevent postpartum hemorrhage.
In contrast, Expectant Management or physiological management relies on the body’s natural processes without routine medical intervention. This approach involves waiting for natural signs of placental separation before assisting with its expulsion. The umbilical cord is typically not clamped or cut until it has stopped pulsating, allowing for continued blood flow to the newborn. Skin-to-skin contact and early breastfeeding are encouraged, as they stimulate the natural release of oxytocin, promoting uterine contractions and aiding placental delivery. This method allows the third stage to unfold spontaneously, with intervention only if complications arise.
Immediate Post-Delivery Monitoring and Care
Following placental delivery, continuous monitoring of the birthing person is important to ensure their safety and prevent complications. The primary concern during this immediate postpartum period is postpartum hemorrhage (PPH), defined as excessive bleeding after childbirth. Uterine atony, where the uterus fails to contract adequately, is the most common cause of PPH.
Healthcare providers regularly assess uterine tone through fundal massage, gently rubbing the top of the uterus through the abdomen. This manual stimulation encourages the uterus to remain firm and contracted, helping to compress blood vessels at the site where the placenta was attached. A well-contracted uterus feels firm, while a “boggy” or soft uterus indicates a risk of increased bleeding. Vital signs, including blood pressure and heart rate, are closely monitored, and blood loss is continuously assessed.
Newborn care also occurs concurrently. Skin-to-skin contact between the birthing person and the baby is encouraged immediately after birth, fostering bonding and promoting oxytocin release, which supports uterine contraction. Initial breastfeeding can also stimulate oxytocin release, further aiding uterine involution. This monitoring and care help detect and manage potential complications promptly, safeguarding maternal health following childbirth.