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3rd stage of labour
Your baby has been born, but it’s not quite over yet. The third stage of labour involves the birth of the placenta and traditionally hospitals like to cut the umbilical cord as the baby’s body is born and then give the woman a syntometrine injection to speed up the process. This is known as a ‘managed’ third stage, because the midwife has to actively help bring the placenta out. Without the injection, the delivery of the placenta can take a little longer, from 15 minutes to an hour normally. With the injection, the placenta is usually delivered in a few minutes.
If you decide not to have syntometrine
Following a normal labour and birth, without medical interventions, your baby can adapt gently to life outside the womb and third stage is part of this. For a few minutes oxygen continues to flow to your baby through the umbilical cord, whilst she takes her first breaths. When it stops pulsating your midwife, or you or your partner, can cut the cord and wait for contractions to restart to birth the placenta. Staying upright and cuddling or feeding your baby will increase the oxytocin flow to help the contractions work. The midwife will not pull the cord to help the placenta come out.
If you decide to have syntometrine
The syntometrine is usually injected into your thigh as the baby’s head and shoulders are emerging. It makes your uterus contract more strongly, so the placenta comes out quickly – in about five minutes. As the uterus contracts, the amount of cord that is visible increases. The midwife will pull the cord gently to help the placenta come out, and you may be asked to push. Once the placenta and membranes are delivered, the midwife will check that they are complete. If you retain a part of the placenta, this can become infected later.
The main disadvantage of syntometrine is that it can have side-effects such as a headache, raised blood pressure or make you feel sick.
Generally, however, it is advisable to have syntometrine if you have had any of the following:
- Bleeding during pregnancy
- A long labour
- Pain-relieving drugs
- An epidural
- A forceps or ventouse delivery
Caesarean birth
About one in five women in the UK give birth to their babies by caesarean section. There are two kinds of caesarean birth:
- ‘Elective’, which means that the caesarean has been pre-arranged, maybe because the baby is in a breech position or you have placenta praevia, or because you have another problem that makes vaginal birth difficult or impossible.
‘Emergency’, which means that there is a problem during labour, such as fetal distress, that necessitates the baby being born as quickly as possible.
Caesareans are usually (but not always, occasionally a general anaesthetic is used) carried out under local anaesthetic, either an epidural or spinal block. You will be awake but won’t be able to feel any pain. You will also have a catheter inserted, to drain your bladder.
The surgeon makes a cut in your abdomen and then in your uterus and gently pulls the baby out.
Once the baby is out, you will be given syntocinon, an artificial version of the hormone oxytocin, to make your uterus contract. The surgeon will then deliver the placenta.
Afterwards, the surgeon will stitch the cut in your uterus and your abdomen, and you will be given a pain-killing drug such as diamorphine.
Usually it takes about ten minutes to birth the baby, and the entire process takes about 40 minutes.
After a caesarean, you will probably stay in hospital for about four days – a little longer than you would stay in after a vaginal delivery. You may experience some soreness around your scar.
It can take longer to recover from a caesarean section than a vaginal delivery, and it is important to avoid driving, carrying heavy objects or doing strenuous exercise for six weeks after the birth.
See "Third stage of labour" for more information.
