What is the third stage of labour?

The third stage of labour begins when your baby is born. During this stage of labour, the placenta and membranes that supported your baby in your uterus come out through your vagina.

Your midwife can help this to happen by guiding the placenta out and by giving you an injection to help your uterus contract. This is called ‘active management’. Some women prefer to deliver their placenta without medical help. This is called 'physiological management'. It is a good idea to discuss your preferences with your healthcare team during your pregnancy and before the birth.

During the third stage of labour, the umbilical cord, which connected your baby to your placenta, is clamped and cut. If you would like the umbilical cord to be left intact, or to be clamped later, you should let your midwife know so that they can arrange this. If your birth partner would like to cut the cord, let your midwife know. You may also like to add this to your birth plan, if you have one.

How long does it usually last?

The third stage of labour generally lasts about 30 minutes if actively managed. If you decide to use physiological management, meaning that you deliver the placenta without medication or hands-on help from your midwife, the third stage can take up to one hour.

What can I do to help the placenta come out?

You may choose to change positions to help the placenta come out. Pushing gently will also help the placenta come out. You may experience mild contractions as the placenta comes away from your uterus.

How can my midwife support the third stage of labour?

If you are actively managing the third stage of labour, your midwife will offer you an injection of a medicine called oxytocin. This helps your uterus to contract after birth. This medicine is used to reduce the risk of excessive bleeding (post-partum haemorrhage), and to reduce the risk of needing a blood transfusion after birth.

Your midwife will support you by checking the position of your uterus and by gently pulling on the umbilical cord when they notice signs that your placenta is ready to come out.

When the placenta begins to come out through your vagina, your midwife will guide the placenta, while gently twisting to make sure all of the membranes come out with it.

Your midwife will also clamp and cut the umbilical cord. This is generally done a few minutes after your baby is born, and after the blood in the umbilical cord has had time to flow into your baby. In some situations, your doctor or midwife may recommend clamping and cutting the umbilical cord immediately after birth. This is usually only needed if you or your baby are very unwell.

Women have different preferences regarding when the umbilical cord should be cut and what should be done with the placenta after delivery. Your health team will do all they can to facilitate and support your decisions, while keeping the health of you and your baby as a top priority.

Do I need stitches after labour?

After your placenta has come out, your midwife will check the skin around your vagina (your perineum) for tears. Your skin can sometimes tear when it is stretched during birth. Your midwife will check if you have a tear and if so, how deep the tearing is and where it is located. Small, shallow tears may not need to be closed with stitches. However, larger tears should be treated to make sure that they heal properly and to reduce your chance of complications afterwards. If you need stitches, your doctor or midwife will offer you medicine for pain relief before you get them. If you have had an episiotomy, this will also need stitches.

Will my birth partner be with me?

Your birth partner can stay with you throughout this stage of labour if you would like them to be. They will be able to support you, for example by reassuring you and bringing you anything you need. If you would prefer that your birth partner is not with you during any part of your 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 your chest or stomach after they are born, with their skin directly in contact with yours. This is called ’skin-to-skin’ contact and it is your first opportunity to hold and cuddle your new baby. Your midwife will cover you both with a blanket to keep you warm. They will also check on you and your baby to make sure you are both doing well. Your midwife will need to measure your baby and give them medicines, but there is no rush. This time is for you to meet your baby and enjoy being with them.

This is also a good opportunity to breastfeed your baby for the first time if you would like to. Breastfeeding can shorten the third stage of labour and reduce the amount of bleeding you experience. This is because breastfeeding causes your body to release oxytocin, which naturally contracts your uterus. Your midwife will show you how to breastfeed your baby if you would like them to. You can breastfeed your baby right after birth (even if you plan to bottle feed later). Some women find that this a great way to start to bond with their newborn.

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