Important: This is intended as general information only. It may not apply to your specific situation.  It is not a substitute for medical advice.  If you have a question or concern, please raise it with me at your next appointment or contact me sooner if it's urgent.

Management of the Third Stage of Labour

The third stage of labour is the time between the delivery of the baby and the delivery of the placenta.  During this time the placenta separates from the wall of the uterus and the uterus contracts to expel the placenta and prevent bleeding. 

Although the third stage doesn’t get much attention, it’s actually very important.  From the mother’s point of view, it’s the riskiest part of having a baby.  This is due to the risk of heavy bleeding or Post Partum Haemorrhage (PPH) during this time.  Due to modern obstetric and midwifery care in first world countries, we are pretty good at preventing and treating PPH.  Despite this, there are several deaths each year from this condition in Australia and it remains an important cause of maternal mortality worldwide. 

One of the ways in which we prevent PPH is by what is known as active management of the third stage.  This involves giving an injection into the mother’s thigh as the baby’s shoulders are delivered.  This injection contains a uterotonic agent - a drug that helps the uterus contract.  The placenta is then delivered by controlled cord traction.  Having an injection at this point is no big deal – given everything else that is happening, most women don’t even notice it.  The medication used can cause nausea (but then, so can having a baby).  A number of large, well-conducted clinical trials have demonstrated that active management of the third stage of labour reduces the risk of PPH and subsequent maternal anaemia. 

Some women prefer what is known as physiological management of the third stage.  Definitions vary but usually what people mean by this is not giving a uterotonic agent and waiting for the placenta to deliver spontaneously.  Some women prefer this on the basis that it is ‘natural’ which it undoubtedly is.  (PPH is also natural).  

Of course, you can decide whether you wish to have active or physiological management of the third stage in your labour, and we will discuss your plans during the pregnancy.  While I will (within reason) support any decision you make, I recommend active management.  I view it as a small intervention to prevent much larger interventions later.  In the event that you do have a PPH, it can usually be managed but this takes time and can cut into the time you would otherwise be spending getting to know your new baby and establishing breastfeeding.  Also, significant blood loss can affect your milk supply make breastfeeding much harder.