Third stage of labour is from when the baby is born until the placenta (afterbirth) is born.  This is commonly a stage which lots of books ignore, Childbirth Educators gloss over in classes and many midwives/doctors do not regard as being all that important.  The attitude is often ‘baby is out and healthy – end of story’.

After the birth, the rush of emotion and having the baby near the breast, or suckling, will cause the pituitary gland to release oxytocin, which causes the uterus to contract and the placenta to separate from the wall of the uterus.

The baby begins to breathe independently through the lungs and, after a few minutes, breathing will be fully established and the umbilical cord will have stopped pulsating.  The placenta and cord continue functioning until breathing is fully established to guarantee the baby a supply of oxygen and a means of getting rid of carbon dioxide.  In the case of distress or a complication, this supply of oxygen is a natural insurance that the baby will receive sufficient oxygen until he or she is capable of breathing independently.

It is dangerous for a newborn to be deprived of oxygen – this can cause brain damage.  It is equally dangerous for the baby to have no means of breathing out carbon dioxide.  If the baby is still receiving oxygen from the placenta (if the umbilical cord is not cut prematurely) this is far less likely to occur.

Once the cord has stopped pulsating it is an indication that the baby no longer requires the ‘goodies’ from the placenta and can breathe independently.  The cord can be cut after it stops pulsating or after the placenta is delivered at the very end.

This third stage should not be hurried.  It is routine in many hospitals to rush this third stage by giving an injection of syntocinon, in the woman’s leg, when the top shoulder appears.

If labour and birth have been normal and spontaneous, there is no need to give syntocinon.  If there is immediate skin to skin and eye contact between mum and her baby this will release oxytocin, the hormone that naturally helps the uterus to

contract.  This is physiological third stage. Most midwives are supportive of letting nature take its course.  Many women find birthing their placenta a pleasurable sensation.

Active management of third stage is the giving of syntocinon, to speed up the third stage.  This is much more likely to happen in situations where the woman has an obstetrician as her caregiver.  They feel like there job is finished once the baby has been born and want to go home!  There will be controlled cord traction (where the Dr. pulls on the cord) until the placenta is delivered.

Risks of Syntocinon:

  • If Syntocinon has been used it necessitates immediate clamping of the cord and controlled cord traction, increasing the risk of a placental fragment remaining, which may cause infection.
  • It also interrupts  final blood exchange through the placenta before breathing is fully established so oxygen supply is reduced.
  • Strong contractions followed by clamping may overtransfuse the baby.
  • Risk of neonatal jaundice is increased and the normal processes of the third stage are reversed.
  • Can cause nausea, and more rarely, an inversion of the uterus, which is a major complication.
  • It is best reserved for those rare cases where a woman is haemorrhaging.