Giving birth - third stage of labour

What is the third stage of labour?

The third stage of labour starts after your baby is born. During this stage of labour, your placenta naturally separates from the wall of your uterus. The placenta and membranes that supported your baby in your uterus during pregnancy are then expelled through your vagina.

This stage is usually less painful than the other 2, but is vital to complete your birth process.

During the third stage of labour, the umbilical cord is also clamped and cut. This is not painful for you and your baby. If you have arranged to bank or donate cord blood, your midwife will process your baby's cord blood after the cord is cut.

Usually, your midwife or doctor will cut the cord only after it has stopped pulsating (usually about a minute after your baby's birth). This is to maximise the amount of blood your baby receives from your placenta, which reduces the chance of iron-deficiency for your baby later on. Your midwife or doctor may need to cut the cord immediately if you or your baby are unwell.

Inform your midwife in advance if you prefer to keep the cord intact or if your birth partner wishes to cut the cord. Consider including this in your birth plan.

How is my placenta delivered?

After your baby's birth, your placenta naturally separates from the wall of your uterus. You may experience mild contractions as the placenta comes away from your uterus. Your midwife may ask you to push gently to help deliver the placenta.

How can my doctor or midwife support the third stage of labour?

There are two possible ways for your doctor or midwife to assist with delivery of the placenta:

• active management (with medical intervention)
• natural third stage — also called physiological or expectant management.

During active management, your doctor or midwife will give you an oxytocin injection to help your uterus contract. This speeds up delivery of the placenta and reduces the chance of excessive postpartum bleeding. If there were complications during pregnancy or labour that put you at a higher risk of excessive postpartum bleeding, your midwife or doctor may recommend an active third stage.

In a natural third stage, your midwife may apply pressure to your abdomen and gently pull the umbilical cord to help ease the placenta out, but there is no other medical intervention.

During the third stage of labour, your midwife can help provide breastfeeding support and will continue to check on you and your baby's wellbeing.

You can discuss your choices with your midwife or doctor during your pregnancy to help you make informed decisions and choices before giving birth.

How long does the third stage of labour usually last?

An actively managed third stage of labour usually takes anywhere from 5 to 30 minutes. If you decide to have a natural third stage, it can take up to one hour.

Will I need stitches after labour?

The skin and tissues between your vagina and anus (perineum) can sometimes tear when it is stretched during birth.

After your placenta has been delivered, your midwife will check your perineum for tears. They will assess how deep these are and where they are located.

Small, shallow tears may not need stitches, but larger tears may be stitched so they heal properly. This will reduce your chance of complications.

If you need stitches for a tear or an episiotomy, your doctor or midwife will offer you pain relief.

Will my birth partner be with me?

Your birth partner can usually stay with you throughout this stage of labour and provide you with support, for example, by reassuring you and bringing you anything you need.

If you prefer privacy at any time during labour, let your midwife know — it's your choice.

Where is my baby during the third stage of labour?

Your baby will be placed on you after they are born, for skin-to-skin contact and you will both be covered with a blanket to keep you warm.

This is also a good chance to breastfeed your baby for the first time, if you would like to. You may find that this a great way to start to bond with your newborn, even if you plan to bottle feed later.

Breastfeeding during this time can:

• shorten the third stage of labour, as it releases oxytocin, which contracts your uterus and aids in the delivery of the placenta
• reduce the amount of bleeding you may have after birth
• keep your baby s blood sugar levels normal

Your midwife may offer to weigh your baby and give them medicines such as a vitamin K injection, but there is no rush. If you are both well, this is a good time for you to meet and enjoy your baby.

What happens if something goes wrong?

Every labour is unique, and sometimes things don t go according to plan. You may have to adjust your birth plan if the situation calls for it. There can be labour complications in which extra medical support is needed.

Your midwife and doctor will communicate and guide you to make the best decisions for you and your baby.

Resources and support

• Speak to your doctor or midwife during a prenatal visit about what to expect in the third stage of pregnancy.
• The Royal Australian and New Zealand College of Obstetricians and Gynaecologists provides a pamphlet on labour and birth.
• Health NSW has created a labour and birth booklet outlining the various stages, what to expect at each stage of the birthing process and as well as how you can be supported.
• You can also listen to our podcast on understanding your choices when having a baby.