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Third Stage of Labour – Process, Risks & Care

The third stage of labour is the final phase of childbirth, during which the placenta and membranes are delivered after the birth of the baby.

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Things worth knowing about "Third stage of labour"

The third stage of labour is the final phase of childbirth, during which the placenta and membranes are delivered after the birth of the baby.

What is the Third Stage of Labour?

The third stage of labour (also called the placental stage or afterbirth stage) is the final phase of childbirth. It begins immediately after the birth of the baby and ends with the complete expulsion of the placenta, fetal membranes, and umbilical cord. This stage typically lasts between 5 and 30 minutes and is a natural physiological process.

How the Third Stage of Labour Progresses

After the baby is born, the uterus continues to contract. These contractions cause the placenta to detach from the uterine wall and be expelled through the birth canal. The process involves the following steps:

Placental separation: Uterine contractions cause the placenta to detach from the inner wall of the uterus.
Descent: The separated placenta moves down into the lower uterine segment and the vagina.
Expulsion: The placenta and membranes are fully delivered, either spontaneously or with gentle assistance.

Active vs. Expectant Management

Modern obstetric practice distinguishes between two approaches to managing the third stage of labour:

Active Management

Active management involves a series of interventions designed to speed up placental delivery and reduce the risk of postpartum bleeding. These include:

Administration of oxytocin (a uterotonic hormone) following the birth of the baby
Controlled cord traction
Early uterine massage

Expectant (Physiological) Management

Expectant management allows the natural process to occur without pharmacological or mechanical intervention. This approach is often chosen in uncomplicated births or at the request of the birthing person.

Possible Complications

Although the third stage of labour is usually uncomplicated, certain problems can occasionally arise:

Retained placenta: The placenta does not fully separate or remains partially inside the uterus.
Primary postpartum haemorrhage: Excessive bleeding after delivery, defined as blood loss exceeding 500 ml following a vaginal birth.
Placenta accreta: An abnormally adherent placenta that cannot detach spontaneously.
Uterine inversion: A very rare condition in which the uterus turns inside out during placental delivery.

Medical Monitoring

Both mother and baby are closely monitored during and after the third stage of labour. The care team checks:

The completeness of the expelled placenta and membranes
The amount of blood loss
The condition of the uterus (tone and size)
The overall cardiovascular status of the mother

The placenta is carefully examined after delivery to ensure that no tissue has been retained inside the uterus, as retained fragments can lead to infection or delayed postpartum bleeding.

Importance for the Mother

The successful and complete third stage of labour is critical to the health of the mother after birth. It allows the uterus to contract, blood vessels to close, and healing to begin. In many cultures, the placenta also holds symbolic or spiritual significance.

References

World Health Organization (WHO): Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. WHO Press, Geneva, 2012.
Coad J., Dunstall M.: Anatomy and Physiology for Midwives. 3rd edition, Churchill Livingstone Elsevier, Edinburgh, 2011.
Begley C.M. et al.: Active versus expectant management for women in the third stage of labour. Cochrane Database of Systematic Reviews, 2019.

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