This is also known as “The Third Stage of Labour”
This is from the delivery of the baby to the delivery of the placenta. This takes about 5-30 minutes depending on how you manage this stage. This is the bit you often don’t hear much about! The Third Stage refers to the moment after your baby is born until the delivery of the placenta. You can chose if you want to have a Managed (assisted) or Physiological (natural) Third Stage. Both are discussed below.
A Managed Third Stage
This is routine in many hospitals. You will be given an injection in your thigh just as the baby is born, before the cord is clamped and cut. The injection will make your womb contract, which will help the placenta to come away and help the blood vessels to seal inside you. The injection will lower the risk of very heavy bleeding and you will be less likely to develop anaemia in the days after the birth.
However, like many drugs, the one in this injection (Syntometrine), it is not without its side effects. The injection can cause-
- High Blood Pressure
- Strong After Pains
There may be cases where your midwife or doctor will recommend strongly that you have this injection. For example if you
- Have had a very long or very fast labour.
- Have a twin pregnancy
- Have heavy bleeding during your pregnancy or labour
- Have an induced labour.
- Have an assisted birth or Caesarean Section.
You do not need to push the placenta out. Your midwife or doctor will pull gently on the umbilical cord and push on your tummy as your womb contracts.
A Physiological Third Stage
This is where you wait for the placenta to be delivered naturally. When the baby is born you will wait for the cord to stop pulsating, and theoretically your womb will contract, causing the placenta to come away from the wall of the womb. You will be encouraged to put the baby on the breast as the act of the baby sucking on your nipples will encourage your womb to contract.
You might feel the placenta coming down into the vagina and you may feel an urge to push it out, bit this is nothing like pushing a baby out. It is much much smaller and very soft and should come out very easily. The midwife may wait until the placenta is delivered before clamping the cord. You can decide whether you would like the midwife or your partner to cut the cord!
With both these methods the midwife will spend some time checking the placenta and the membranes to make sure that the placenta is complete and that nothing has left inside you as this can very dangerous.
As we mentioned, the injection reduces the risk of heavy bleeding after delivery. It is important to know that if you do not have the injection then the likelihood of heavy bleeding is about 15% but if you have the injection it falls to about 5%. If you do not wish to have this injection then you should let your midwife or doctor know before hand. However, we strongly advise that you do have the injection. It is perfectly safe and reduces the risk, by three times, the chance of major bleeding.
What Happens Next?
The midwife or doctor will check you very carefully to make sure you are not bleeding excessively and to see if there has been any damage to your vagina, vulva, anus or perineum. (This is the area between your vagina and anus). This can be uncomfortable and sometimes painful but you will be offered some Gas and Oxygen if needed. If you do need stitches, then these can sometimes be done without you having to move. Sometimes you may need to be transferred to an operating theatre.
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