Third stage of labour

The third stage of labour happens after your baby is born, when your womb contracts and the placenta comes out through your vagina.

There are two ways to manage this stage of labour:

• Active – when you have treatment to speed things up
• Physiological – when you have no treatment and this stage happens naturally

Your midwife will explain both to you while you're still pregnant or during early labour, so you can decide which you would prefer. 

There are some situations where physiological management isn't advisable. Your midwife or doctor can explain if this is the case for you.

What is active management?

• Your midwife gives you an injection of oxytocin in your thigh as you give birth or shortly after. This makes your womb contract.
• Evidence suggests it's better not to cut the umbilical cord straight away, so your midwife will wait to do this between one and five minutes after birth. This may be done sooner if there are concerns about you or your baby – for example, if the cord is wound tightly around your baby, or is a short cord.
• Once the placenta has come away from the womb, the midwife pulls the cord – which is attached to the placenta – and pulls the placenta out through your vagina, whilst pressing firmly on your tummy. This usually happens within 30 minutes of your baby being born.

Active management speeds up the delivery of the placenta and lowers your risk of having heavy bleeding after the birth (postpartum haemorrhage ), but increases the chance of you feeling nauseous and vomiting. It can also make afterpains – contraction-like pains after birth – worse.

What is physiological management?

• No oxytocin injection is given, and the third stage of labour happens naturally.
• The cord isn't cut until it's stopped pulsing – this means blood is still passing from the placenta to your baby. This usually takes around 2-4 minutes.
• Once the placenta has come away from the womb, you should feel some pressure in your bottom and contractions, and you'll need to push the placenta out. It can take up to an hour for the placenta to come away, but it normally only takes a few minutes to push it out.

If the placenta doesn't come away naturally or you begin to bleed heavily, you'll be advised by your midwife or doctor to switch to active management. You can do this at any time during the third stage of labour.