What happens after the birth of your baby – birthing your placenta

What happens after the birth of your baby – birthing your placenta

The arrival of a baby is a time of excitement, questions and decisions. Natural birth or caesarean? Pain relief or no pain relief? What about the delivery of the placenta and clamping of the cord?

After your baby is born the placenta detaches from the womb and the placenta and umbilical cord are expelled. This is called the third stage of labour and normally takes about 10 minutes but can sometimes take longer.

During this time the uterus contracts to help with the placenta coming away and stopping the bleeding.  Occasionally this process doesn’t happen normally and can result in a big bleed, called a postpartum haemorrhage.

As obstetricians we are commonly asked two common questions in relation to the third stage of labour. Firstly there is the question of whether or not to speed up the time it takes for the placenta to come out and secondly there is the question of when to clamp the cord. 

Active vs expectant management for delivery of the placenta?

We recommend active management  of the third stage, which involves an injection of a medication into your thigh shortly after your baby is born to reduce bleeding after birth.

Some women may request expectant management, which is when the placenta is left alone to detach without medication or intervention to help with contraction of the uterus. Occasionally this can cause greater blood loss and increase the risk of a retained placenta, which is where the placenta doesn’t come out. 

The doctor or midwife looking after you may advise against expectant management if you have risk factors for postpartum haemorrhage. They may recommend changing from expectant management to active management if they are worried about excessive bleeding or if delivery of the placenta is slow.

If you have questions about this they can discuss it with you in more detail.

When is the umbilical cord clamped?

The second common question we encounter relates to the timing of umbilical cord clamping. The umbilical cord contains the vessels which transport oxygen and nutrients between you and your baby via the placenta. After birth the cord will continue to pulsate for some time and some blood will continue to be transferred to the baby during this time, however the majority of this blood transfer takes place in the first 60 seconds after birth.

With cord clamping you have two choices, immediate cord clamping or delayed cord clamping.

Immediate cord clamping is fairly self-explanatory with the cord being clamped as soon as the baby is born. Delayed cord clamping is when the cord is clamped some time after the baby is born.

At the Mater delayed cord clamping is performed 60 seconds after the baby is born. In some situations, for example if your baby needs help with breathing, delayed cord clamping may not be appropriate. If you are having a caesarean or would prefer a longer timeframe it is best to discuss this with your midwife or obstetrician.

Delayed cord clamping for babies born at term increases body iron stores at the 3 – 6 month mark. It may also be associated with small improvements in childhood development and some studies show there are additional benefits to babies born preterm including the reduced need for a blood transfusion and perhaps decrease the risk of brain and bowel complications in the first few weeks after birth.

Delayed cord clamping in full term babies might increase the risk of jaundice and the likelihood of needing treatment for this with phototherapy.

Another thing to consider is if you want to donate cord blood delayed clamping may mean that there is not enough blood left in the placenta to donate. 

For further information please ask your obstetrician or midwife or have a read of our brochures below.

The placenta and umbilical cord

Labour and birth—the third stage

Labour and birth—cord clamping


 

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