Expert / 9 May, 2023 / My Baba
Often referred to as the third stage of labour, after delivering the baby, the final stage is to deliver the placenta, commonly known as the ‘afterbirth’. Natural or ‘physiological’ delivery of the placenta means no pain relief is given, and the placenta is delivered naturally with contractions when there are signs of separation from the womb lining. This can take anywhere from ten minutes to an hour.
The alternative is ‘active’ delivery – also known as managed or assisted management – in which an injection (oxytocin) is administered by your midwife into the thigh, helping the womb to contract and the placenta to separate, whilst ensuring the blood vessels seal properly afterwards. Once the womb contracts, the midwife will then pull gently on the cord, helping the placenta come out.
It’s important to discuss the pros and cons of each method with your midwife or obstetrician, taking into account your individual risk factors before you decide. Active management significantly reduces the amount of blood loss with placenta delivery and does not stop you having delayed cord clamping.
As mentioned above, physiological delivery means that no oxytocin is administered, and instead the delivery of the placenta happens spontaneously. In this instance, the umbilical cord is not cut until the blood has finished passing from the placenta to the baby. This will usually take around two to four minutes but can take up to an hour, at which point the placenta will come away from the womb. This can in some instances result in a feeling of pressure inside your bottom, and similarly to vaginal birth, the placenta will need to be pushed out. Once the placenta has come away from the womb (this can take up to an hour), the placenta can be birthed in as little as a few minutes.
If the placenta fails to come away naturally, or the mother begins to bleed heavily, the medical practitioner will advise switching to active delivery.
An active delivery of the placenta is generally routine and advised in most hospitals, usually taking less than ten minutes and expected by 30 minutes after birth. It’s recommended because it significantly reduces your risk of heavy blood loss after your birth, or in rare and more extreme cases, preventing severe haemorrhage. However, there can also be some mild side effects that can follow the administered injection in active delivery. These usually manifest in nausea, vomiting, headaches, increased blood pressure and occasionally abdominal cramps. However most women have barely any side effects.
Generally, delivery of the afterbirth is not painful. This is particularly true of mothers’ who have opted for an epidural. Others may feel an urge to push the placenta out but describe the feeling of delivering the placenta as more like a bowel movement than delivering a baby. It can vary from person to person but is not painful.
Alternatively, compared to vaginal births, most caesarean sections are planned in advance (more commonly referred to as elective c-sections). However, there are times when a vaginal birth is planned but throughout labour it becomes necessary to deliver the baby by caesarean section – for either the safety of the baby or the mother (this is called an emergency caesarean section).
The majority of caesareans are performed under regional anaesthetic, meaning that although the mother is awake throughout the procedure, the lower section of her body is completely pain free. Once the anaesthetic is working, the abdomen of the mother will be cleaned carefully with antiseptic, and the bladder will be emptied. A low abdominal horizontal cut will be made, and the baby will be delivered within around five 5-10 minutes.
After the baby is delivered, two methods can be used to deliver the placenta, either cord traction (as with a vaginal birth) or manual removal. For manual removal, the medical practitioner will separate the placenta from the uterine cavity after the delivery of the baby. Alternatively, chord traction, means the surgeon will perform gentle traction on the exposed umbilical cord, to facilitate the delivery of the placenta. It’s actually similar to vaginal birth as medication is given to help the placenta separate promptly and thus reduce bleeding. It is routine to allow delayed cord clamping with a caesarean too if mother and baby are both well.
After the surgeons are confident that each part of the placenta has been removed, the mother will be stitched back up which can take anywhere from 30-40 minutes.
The mother can decide either to take the placenta home after birth or the midwife will dispose of this. It’s important to let your midwife/medical practitioner know if you would like to keep the placenta in advance, otherwise it will be discarded. Some parents opt for Stem cell banking or placenta encapsulation in which case the team you have organised will take the placenta and cord.
Occasionally if your Obstetrician is concerned about your baby’s growth or wellbeing the placenta might be sent for examination in the lab by a pathologist – but they will discuss this with you at the time of birth.
Article by Dr Shazia Malik, Obstetrician and Gynaecologist at The Portland Hospital (part of HCA Healthcare UK)
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