Retained placenta

Retained placenta is when some of the placenta stays in your uterus after your baby is born.

Retained placenta happens in around 2 out of every 100 births.

If untreated, a retained placenta can lead to severe infection or life-threatening blood loss.

After your baby is born, you will need to birth the placenta. This is called the third stage of labour. This can take anywhere from 5 to 60 minutes after you give birth to your baby.

There are two approaches to managing the third stage, known as:

• active management (with medical assistance)
• physiological or expectant (without medical assistance)

You may choose to 'actively manage' this stage of labour which means that your midwife or doctor will do some or all of these steps:

1. Give you an injection of synthetic oxytocin to help your uterus contract.
2. Clamp and cut your baby's umbilical cord.
3. Gently pull on the umbilical cord; this helps speed up the birthing of the placenta.
4. Massage or press down from the top of your belly.

Active management can reduce the risk of heavy bleeding when there are also other factors that add to your chance of bleeding from the vagina (postpartum haemorrhage) following birth.

Choosing natural management means that you want to wait for the placenta to pass through the birth canal naturally, with the help of gravity and some contractions. This may take up to one hour. You can usually hold your baby during the third stage of labour.

Your midwife or doctor can help you make an informed decision about which option is best for you. It is fine to ask questions if you don’t understand what is happening. You can also have pain relief as needed.

You may choose to write your preferences a birth plan.

If you attend antenatal classes, you can find out more about the stages of labour. You can also ask your midwife questions about what happens in the third stage, at your regular visits. 

Symptoms of a retained placenta include:

• fever (Opens in new tab)
• heavy bleeding
• bad-smelling discharge from your vagina
• many large clots coming out of the vagina

The placenta may be retained after your baby is born if:

• your contractions aren't strong enough to deliver it
• you have placenta accreta (when the placenta implants too deeply into the wall of the uterus)
• the cervix closes before the third stage of labour is complete and traps the placenta inside your uterus
• your bladder is full, blocking the delivery of the placenta

There is nothing you can do differently to prevent it. However, if you have any of the symptoms of retained placenta, see your midwife or doctor straight away.

It’s important to contact your midwife or medical team as soon as possible if you pass many large clots or your post-birth bleeding becomes:

• heavier
• bright red
• foul-smelling

It is normal to experience bleeding after the birth of your baby. The amount of bleeding varies from person to person. Most people have moderate to heavy bleeding for the first few days which gradually decreases and becomes more brownish. Usually, the bleeding stops between 4 to 6 weeks after you give birth.

It is also common to bleed more heavily right after breastfeeding, but this should settle quickly.

Most women have a postnatal visit with their doctor or midwife about 6 weeks after birth.

Your doctor or midwife will diagnose retained placenta if the placenta hasn’t completely emerged from your uterus within 30 minutes (if you are actively managed and have had oxytocin) or 1 hour (if you choose natural or physiological management).

After you give birth to your baby and the placenta is delivered, the midwife or doctor will check your placenta to make sure it is complete. This is to ensure no placenta material was left behind. They will need your permission to do a vaginal examination. 

If you have symptoms of retained placenta in the days or weeks after birth, your doctor may refer you for an ultrasound scan to check.

If you have just given birth, your midwife might suggest these steps if there is a delay in delivering the placenta:

• emptying your bladder — this might mean inserting a catheter (tube) to release urine (wee) or getting up to use the toilet
• changing your position
• encouraging breastfeeding or nipple stimulation
• your doctor or midwife gently pulling on the umbilical cord
• giving you medicine

If that doesn’t work, or your doctor diagnoses retained placenta days or weeks after your baby’s birth, you may need surgery to remove the placenta. This surgery is usually done with an epidural or general anaesthetic (Opens in new tab), so you won't feel any pain. Your doctor or midwife will do an ultrasound to check for retained parts of the placenta before the procedure.

If you have had a home birth, and have retained placenta, you will likely need to go to hospital by ambulance for treatment.

While you’re waiting for surgery, your midwife will monitor your bleeding and general health.

If you needed help to deliver your placenta, especially if you had a fever or needed surgery, it’s likely your doctor will also recommend antibiotics to prevent infection.

Possible complications of retained placenta include:

• uterine infection (endometritis)
• postpartum haemorrhage (bleeding)

Learn more about postpartum haemorrhage.

If you experienced complications during birth, you may need to recover for longer than expected in hospital. Recovery is sometimes more difficult if your birth didn’t go as planned.

If you needed to surgery to remove a retained placenta, you may have experienced perineal tears. You will be given information to support healing. 

Your emotional recovery

If you experience unexpected problems during pregnancy and birth, you may feel a lot of different emotions. Try to find a time to speak with your midwife about what happened and how you are feeling. They can help you and your family as you recover. Talking to your partner, family member or a friend can be helpful too. Or try writing about your experiences in a journal. You can also talk with your midwife or doctor at your 6-week postnatal check. 

Learn more about the emotional impact of birth trauma.

You have the right to expect trauma informed care in future.

If you need to talk to someone about your mental health call Beyond Blue (Opens in new tab) on 1300 22 4636.

Visit the Royal Women’s hospital page to learn about the stages of labour.

You can find further help and information from these organisations:

• The Australian Birth Trauma Association (Opens in new tab) offers advice, resources, and a peer support service.
• The Centre of Perinatal Excellence (COPE) (Opens in new tab) has information and a list of support services.
• Perinatal Anxiety & Depression Australia (PANDA) (Opens in new tab) has phone counselling support.