Delivering the placenta

You have 2 options for how to deliver the placenta after giving birth. Here, we explain what these are so you can decide what is best for you. 

The placenta is the organ that supplies nutrients to your baby through the umbilical cord.

If you have a vaginal birth, you will deliver (push out) the placenta through your vagina after your baby is born. This is called the third stage of labour.

If you have a caesarean section, your medical team will deliver the placenta after your baby is born. They will do this through the incision in your womb and stomach (tummy).

What are the 2 options for delivering the placenta after a vaginal birth? 

Your options are:

• to take medication to move things along (active management)
• to let it happen in its own time (physiological management).

Your midwife or doctor will talk to you about your options and the pros and cons of each during pregnancy and again during labour. 

How you deliver the placenta is your decision.

Active management means you may be less likely to have heavy bleeding after birth (known as postpartum haemorrhage).

Your healthcare professional can talk to you about your risk of bleeding after birth so you can make the right choice.

Active management

Active management is when your midwife gives you an injection of a hormone called oxytocin into your thigh, most often as you give birth. 

Oxytocin helps your womb to contract. Having extra oxytocin speeds up delivery of the placenta, which usually happens within 30 minutes. 

Some people may feel sick or vomit after having the injection. Your healthcare professional can give you some anti-sickness medication.

"I had the injection, but hardly knew it was happening, and can’t really remember delivering the placenta!"

Lindsay

Physiological management

Physiological management is when you deliver the placenta without an oxytocin injection. You will still have contractions but they won't be as strong as with an oxytocin injection. 

Physiological management can take up to an hour. It may suit you if you have a low risk of bleeding after birth.

You can write your choice into your birth plan if you've thought about it in time. If you have a birth partner it’s also a good idea to let them know what you’d prefer too. 

Remember you can change your mind at any time if you want to, though.

What will happen if there are problems delivering the placenta?

If you choose not to have medication and there are problems delivering the placenta you may be encouraged to:

• breastfeed your baby
• Have your baby lie on your chest for skin-to-skin contact.

This helps your body naturally release oxytocin to help your womb contract and deliver the placenta. Your midwife may also encourage you to empty your bladder.

If your placenta is not delivered within 1 hour, or you have heavy bleeding, your midwife will advise you to move to active management (have the oxytocin injection). 

What is a retained placenta?

A retained placenta is when the placenta stays in the womb for longer than expected. 

Your midwife or doctor will diagnose a retained placenta if it is not delivered:

• within 30 minutes of your baby’s birth if you have active management, or
• within 1 hour of your baby’s birth if you have physiological management.

A retained placenta needs to be treated early to prevent complications such as heavy bleeding known as primary postpartum haemorrhage (PPH). Although this sounds scary, your midwife or doctor will be ready to treat PPH wherever you are giving birth.