Third Stage of Labour: Natural or Managed?

The third stage of labour is finally a topic of conversation. While we’ve been able to have democratic discussions with our midwives and doctors about most of our birthing preferences for many years, the third stage of labour has long been veiled in approximately six parts indifference and four parts ignorance. After all, when you’re about to bring forth a whole new person, a person that could well be the circumference of a watermelon, you’re not likely to be fixated on the finer points of placental delivery and cord clamping.

Of course, deciding where to give birth, with whom and to which soundtrack is all important preparation, and could help things go smoothly when the big day arrives. In recent years, however, there has been an increasing trend amongst women to reclaim the birthing process from medical professionals. First came the realisation that birth without cesarean section isn’t passive. Contrary to soaps, films and generally accepted wisdom, women don’t have to give birth lying on their backs and are likely to find things a lot more difficult if they attempt to do so.

Next came skin-to-skin. Up until shockingly recently, babies were swaddled in so many layers of cotton before reaching their mothers that the little one probably believed his or her mother shared a natural scent with Fairy Non-Bio. Again, we had to unlearn what we had been taught and look at the facts of the needs of both baby and mother sensibly.

More recently, parents have been rightly concerned about delayed cord clamping and are increasingly insisting that their midwives and obsteatricians wait for at least one minute post-partum to clamp their child’s umbilical cord, enabling the baby to benefit from the nutrient-rich blood stored in the placenta and umbilical cord.

What are the Three Stages of Labour?

Professionals describe labour as divided into three stages as a kind of shorthand for communicating your progress to others. This is what they mean:

  • First stage: your contractions gradually open up the cervix, the neck of your uterus
  • Second stage: you push your baby out into the world
  • Third stage: you deliver the placenta

The first two stages of labour are obviously more interesting than the third, which is probably why the final stage is largely ignored by expectant parents. There are, however, some important reasons to get informed about the third stage of labour and to get involved in the decisions that will be made about your own third stage.

What should I know about the third stage of labour?

The National Childbirth Trust (NCT) describes the third stage of labour simply and clearly:

After your baby has been born the placenta, which has sustained your baby throughout pregnancy, is no longer needed; you need to push it out along with the remaining part of the umbilical cord that runs between the placenta and your baby.

After your baby has been born, your midwife or obstetrician will make two important decisions:

  • When to clamp and cut the umbilical cord.
  • Whether to manage your placental delivery by giving you an injection, or whether to let nature take its course

The first decision will depend on the needs of your baby and those of you and your family. You can read more about delayed cord clamping and its compatibility with cord blood banking here.

Your options: the two types of third stage

If you have not discussed the third stage of labour with your midwife or obstetrician before birth, and do not have your wishes recorded in your birth plan, you will probably have an ‘active’ or managed third stage. This means you will be given a drug that helps the placenta to separate and be discharged from the uterus under controlled conditions. Most births in the UK have an active third stage, and this is particularly likely if you give birth in a hospital or have any health conditions that could lead to haemorrhage.

The delivery of the placenta can also be physiological. This is often referred to as a ‘natural third stage’.

According to NICE guidelines, care in the third stage of labour can be ‘active’ or ‘physiological’ and includes:

Active management of the third stage:

  • routine use of uterotonic drugs
  • deferred clamping and cutting of the cord
  • controlled cord traction after signs of separation of the placenta.

Physiological management of the third stage:

  • no routine use of uterotonic drugs
  • no clamping of the cord until pulsation has stopped
  • delivery of the placenta by maternal effort.

So, which is better? An active or physiological third stage?

Your choice of third stage will depend on your health and beliefs. Many women are now choosing a natural third stage as a logical progression of a drug-free birth and delayed cord clamping. Others choose an active birth as this is associated with a lower risk of serious bleeding.

The third stage of labour has two associated risks, the most serious of which is a haemorrhage, the second is nausea and vomiting.

An active third stage is associated with an approximate risk of 13 in 1,000 of a haemorrhage of more than 1 litre or blood, and an approximate risk of 14 in 1,000 of a blood transfusion.This is significantly lower than the risk of haemorrhage in physiological births where there is an associated risk of 29 in 1,000 of a haemorrhage of more than 1 litre and an approximate risk of 40 in 1,000 of a blood transfusion.

The risk of nausea and vomiting, on the other hand, is much lower with a physiological birth where it affects 50 in 1,000 women, compared to 100 in 1,000 women in active births.

Is cord blood banking compatible with a natural third stage?

Yes! Cord blood can be collected from your baby’s umbilical cord within 3 minutes of the birth of your baby. This means that you can successfully practice delayed cord clamping and cord blood banking: protecting your baby’s health at the time of birth and for the future.

The placenta does not need to be delivered before blood is collected from the umbilical cord, so you needn’t rush your third stage of labour if you wish to store cord blood.

Is cord blood banking compatible with a managed third stage?

Yes! Your baby’s cord blood can be collected without any changes to your birth plan.

How do I organise cord blood banking?

Simply get in touch with us via our phone number or email address at the top of the page, or complete your contact details here.

We are always happy to discuss your options and are never pushy. You can find out about our experience, accreditations and team on our about page.

stem cell preservation

BSc (Hons) Microbiology

Chief Executive Officer | Biovault Family

Biovault Family CEO, Kate Sneddon, joined Biovault in July 2009 and became Chief Executive Officer in 2016. As health industry professional her experience includes working as a microbiologist and leader at GSK for over 10 years. Her expertise in cord blood banking has been recognised in her awards, features in Parliamentary Review and Parents Guide to Cord Blood, as well as contributions to research with UCL and others.

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