Your baby is finally here. You hold the tiny body against your chest, feel the warmth and that newborn smell. All focus has been on pushing the baby out — but technically, the birth isn't quite over yet.
The third stage of labor — delivering the placenta — is the part of birth that few people talk about. Here you'll find out what happens, what to expect, and why this last step is completely uncomplicated for the vast majority.
What Is the Placenta?
The placenta is the organ that, together with the membranes and umbilical cord, has been your baby's lifeline throughout pregnancy. It delivered oxygen and nutrients, and removed waste products.
The placenta is attached to the inside of the uterine wall. After the baby is born, it has done its job and must detach. Your body handles this naturally.
The placenta in numbers:
- Weighs about 1–1.5 lbs / 500–700 grams at term
- Is about 6–8 inches / 15–20 cm in diameter
- Has had over 300 liters of blood flowing through it daily
- Contains over 60 kilometers of blood vessels
What Happens in the Third Stage of Labor?
After the baby is born, the uterus continues to contract. These contractions detach the placenta from the uterine wall. You'll feel them as mild cramps — far less intense than labor contractions.
Step by step:
- The baby is born and placed on your chest (skin-to-skin)
- The umbilical cord continues to pulse for a few minutes
- The cord is cut (by your partner, midwife, or yourself)
- The uterus continues to contract
- The placenta detaches and slides out
- The midwife or doctor checks that the placenta is complete
The whole process usually takes five to thirty minutes. For most people, it is a short and uncomplicated part of the birth.
You are probably so focused on the baby that you barely notice the placenta coming out. Many people describe it as a small push or a sliding sensation.
Delayed Cord Clamping
Previously, the umbilical cord was cut immediately after birth. Today, the WHO and AAP recommend waiting at least one to three minutes — ideally until the cord has stopped pulsing.
Benefits of delayed cord clamping:
- The baby receives up to 30% more blood from the placenta
- Increases the baby's iron stores in the first months
- Provides a gentler transition for the baby
- May help prevent iron-deficiency anemia in the infant
The cord pulses for about two to five minutes after birth. When it stops pulsing, the blood transfer has stopped naturally. It can then be cut by whoever you choose — your partner, the midwife, or yourself.
Discuss the timing of cord clamping in your birth plan. Most midwives and doctors already practice delayed cord clamping, but it's worth having it written down.
Active vs. Expectant Management
There are two approaches to the third stage of labor: active and expectant (physiological) management. Your midwife or doctor will discuss this with you.
Active Management
With active management, the midwife or doctor gives an injection of oxytocin (synthetic uterine stimulant) into the thigh immediately after the baby is born. This causes the uterus to contract quickly and delivers the placenta faster.
Benefits:
- Faster — placenta typically delivered within five to ten minutes
- Lower risk of heavy bleeding
- Recommended when bleeding risk is elevated
Often used with:
- Long labors
- Induced labor
- Previous bleeding complications
- Twin births
Expectant (Physiological) Management
Here the body is allowed to work on its own. Skin-to-skin contact and early breastfeeding stimulate natural oxytocin production, which in turn causes the uterus to contract.
Benefits:
- Completely natural process
- No medication
- Suitable for uncomplicated births
Takes: Fifteen to thirty minutes, sometimes up to an hour.
Many hospitals use active management as standard, unless the birthing person prefers otherwise. Talk to your midwife or doctor about your preferences.
Skin-to-Skin and the First Feeding
While the placenta is being delivered, the best thing for your baby is to lie skin-to-skin on your chest. The warm, naked contact regulates the baby's temperature, breathing, and heart rate.
Most babies begin searching for the breast on their own within the first hour. They crawl, lick, and explore. This "breast crawl" is an innate reflex.
The first breastfeed gives the baby colostrum — the nutritious, antibody-rich first milk. At the same time, the suckling stimulates your oxytocin production, which helps the uterus contract and reduces bleeding.
What Does the Midwife Do Afterward?
After the placenta is delivered, the midwife or doctor checks it carefully. This is a routine check to make sure everything has come out.
Checked:
- That the placenta is complete (no remnants left in the uterus)
- That the membranes are intact
- That the umbilical cord has three blood vessels (two arteries, one vein)
- The amount of bleeding
If parts of the placenta are missing, a procedure to remove the remnants may be necessary. This is uncommon but is done to prevent bleeding and infection.
The midwife also examines the birth canal for any tears. Small tears (grade 1–2) often heal on their own or are sutured with local anesthesia. Larger tears are treated more thoroughly.
Rare Complications
The third stage of labor is uncomplicated for the vast majority. But it is good to know what can happen in rare cases.
Retained Placenta
If the placenta has not detached after thirty to sixty minutes, the midwife or doctor may try to help it out manually. In very rare cases, this is done under anesthesia.
Postpartum Hemorrhage
Some bleeding is normal. But heavy bleeding (over 500 ml) is called postpartum hemorrhage and requires prompt treatment. The risk is low, and medical staff are prepared to handle it.
Birth teams are prepared for all eventualities. Complications with the placenta delivery are rare and are handled quickly and effectively. Trust the team around you.
Frequently Asked Questions
Does it hurt when the placenta comes out?
Most people experience mild discomfort — far less painful than labor itself. Many barely notice it because they are focused on the baby.
Can I see the placenta?
Yes. Many midwives and doctors are happy to show you the placenta and explain what the different parts are. It is a remarkable organ that kept your baby alive for nine months.
What happens to the placenta afterward?
In most hospitals, the placenta is disposed of as biological waste. Some parents wish to take it home — for example to bury it under a tree. Let your midwife or doctor know in advance.
How much will I bleed after birth?
Postpartum bleeding (lochia) lasts four to six weeks. The first week it may resemble heavy menstrual bleeding. The amount decreases gradually. Contact your doctor if you experience heavy bleeding, foul-smelling discharge, or fever.
What is the difference between a cesarean and vaginal placenta delivery?
With a cesarean, the surgeon manually removes the placenta during the operation. The process is the same — the placenta detaches from the uterine wall — but it is performed by the doctor, not by the body itself.
Learn more about the entire birth process in our guide to the stages of labor. Read about the first hours with your newborn and how to prepare for your hospital stay.