The third stage: delivering the placenta

Birth has a quiet epilogue that the movies always skip: after your baby arrives, your placenta still has to follow. This is the third stage of labour — usually brief, usually unremarkable, and worth understanding in advance because it involves one genuine decision and one safety story.

What happens. Once your baby is born, your uterus keeps contracting — gentler now — which peels the placenta away from the uterine wall and moves it down to be delivered. Compared with what you’ve just accomplished it’s a footnote: soft, squashy, and typically over within five to thirty minutes, while your attention is entirely elsewhere, ideally on the small person on your chest.

The decision: managed or natural. In Australia you’ll usually be offered active management — an injection of a synthetic oxytocin into your thigh as (or just after) your baby is born, which makes the uterus clamp down firmly, delivering the placenta sooner and, crucially, reducing the chance of heavy bleeding. This is the recommended default here, and for good reason: postpartum haemorrhage is the complication the third stage exists to avoid, and the injection meaningfully lowers that risk. The alternative — physiological (expectant) management — skips the injection and lets your own hormones do the work, which can take up to an hour and suits some low-risk births; skin-to-skin and early breastfeeding help, since baby at the breast releases exactly the right oxytocin. If that appeals, talk it through with your midwife during pregnancy — whether it’s advisable depends on your risk picture, and if bleeding starts, management can switch in seconds.

Delayed cord clamping fits alongside either choice. Waiting a minute or more before clamping the cord lets extra blood reach your baby, and it’s routine practice now — you don’t have to pick between it and the injection.

Afterwards, your midwife will inspect the placenta carefully (checking it’s complete — fragments left behind can cause bleeding or infection later), press on your tummy to check your uterus is contracting into a firm ball, and keep an eye on your bleeding. Expect period-like cramping (“afterpains”, stronger with second and subsequent babies, especially while feeding) and a firm belly massage or two — briefly unpleasant, genuinely useful.

The safety story is the reason all this attention exists: heavier-than-normal bleeding (postpartum haemorrhage) is uncommon and very treatable, but the third stage and the hours after are its window, which is why your midwife hovers, checks and re-checks. It’s also worth knowing for later: if your bleeding suddenly becomes very heavy at home in the days after birth — soaking pads hourly, or passing large clots — that’s a call-000-or-go-straight-in situation, not a wait-and-see one.

Two small footnotes people wonder about. Yes, you can look at the placenta — it’s genuinely impressive, the only organ your body built from scratch for a nine-month contract — and if you have cultural or personal plans for it (taking it home to bury, for instance), tell your midwife in advance so it’s handled accordingly. And no, you don’t need to do anything to prepare for the third stage beyond knowing your preference. Put it in your birth notes, then let it be the epilogue it usually is: a few minutes of housekeeping while you meet the point of the whole exercise.