The Third Stage of Labour: The Birth After the Birth

Something I never realized until I started learning about birth during my first pregnancy was this: birth isn’t over when you’re holding your baby.

There is still one more important part of labour left after your baby is born: the delivery of the placenta. The organ your body grew to nourish your baby needs to detach and be born too.

For many people, this comes as a surprise. Contractions don’t simply stop once your baby arrives. Your uterus still needs to contract to release the placenta and then clamp down firmly to prevent excessive bleeding. This process is known as the third stage of labour, and it’s one of the least discussed parts of birth.

The third stage refers to the time between the birth of your baby and the birth of the placenta. For some, this happens quickly. For others, it can take much longer. The goal is always the same: a safe delivery of the placenta and prevention of hemorrhage, but how that goal is achieved is not one-size-fits-all.

In many hospital settings, the third stage is managed routinely. This usually means synthetic oxytocin (Pitocin or Syntocinon) is given shortly after birth, the umbilical cord is clamped early, and gentle traction is used to help deliver the placenta. During this step, a care provider places one hand on the abdomen to support the uterus and uses the other hand to gently pull on the umbilical cord as the uterus contracts. The goal is to shorten the length of the third stage and reduce bleeding. This is often very painful and many times unnecessary. This approach is often presented as standard care, with little discussion ahead of time.

Managed third stage can reduce the risk of postpartum hemorrhage in certain situations, particularly when there are known risk factors for complications. It can also lead to stronger after-birth cramps, interfere with the body’s natural oxytocin release, and limit opportunities for delayed cord clamping. For many women, the concern isn’t the medication itself, but that it’s often given automatically - without clear explanation or explicit consent. This is what happened to me.

Pitocin is frequently administered through an IV or saline lock in hospital births, which means it may be given without the mother realizing medication has even been started. An IV is not actually required for third-stage management. If hemorrhage occurs, oxytocin can be given quickly as an injection in the thigh. Despite this, routine IV access and automatic medication can blur the line between preparedness and consent.

Another option is a spontaneous, or physiologic, third stage. In this approach, the placenta is allowed to deliver on its own without routine medication or traction. The uterus contracts naturally, supported by skin-to-skin contact, warmth, and early breastfeeding. All of which stimulate the body’s own oxytocin. Care providers monitor closely for signs of placental separation and bleeding and intervene only if necessary.

A spontaneous third stage does not automatically increase the risk of hemorrhage in low-risk situations. Unmedicated labours often preserve the hormonal cascade that supports strong uterine contractions after birth. Natural oxytocin helps the uterus clamp down effectively, which can reduce bleeding. This doesn’t mean spontaneous management is always the right choice, but it does mean risk should be assessed individually, not assumed.

It’s also important to understand that while Pitocin is used to prevent hemorrhage, it can, in some cases, contribute to it. Synthetic oxytocin does not behave the same way as the body’s natural oxytocin. When Pitocin is given routinely or in higher doses, the uterus can contract strongly at first and then become fatigued. A tired uterus may struggle to maintain the firm, sustained contractions needed after the placenta is delivered, increasing the risk of uterine atony, the most common cause of postpartum hemorrhage. This paradox is rarely discussed, but it’s part of why routine use does not guarantee protection and why individualized decision-making matters, especially when risk is low.

In hospital settings, the third stage is often treated as something that needs to be completed quickly. Women may feel put “on a clock,” with pressure to deliver the placenta within a short window of time. In reality, a safe and well-supported spontaneous third stage can take much longer, even up to a few hours, without being dangerous when bleeding is normal, and mother and baby are stable.

Despite this, many women go through pregnancy without ever learning that the third stage exists, let alone that there are different ways it can be managed. When care is treated as routine, there is little room for true informed consent.

Informed consent requires more than a standard protocol. It means knowing there is a third stage of labour, understanding the available options, discussing benefits and risks, and having your individual circumstances considered. If it wasn’t explained, it wasn’t a choice.

Even if you plan to remain flexible, these are conversations worth having before labour begins. You can ask how the third stage is typically handled, whether spontaneous management is an option in low-risk births, and under what circumstances medication would be recommended. Including your preferences in your birth plan helps ensure this stage of labour receives the same thoughtful attention as the rest of your birth.

Birth doesn’t simply end when your baby arrives.
The third stage of labour is the birth after the birth, and you deserve to understand it before you’re in it.

If this blog opened your eyes to how much isn’t routinely explained… imagine walking into birth already confident and informed.

I created a free 30-minute class that walks you through:
• Why are so many women choosing unmedicated birth
• The biggest obstacles that catch families off guard
• Simple, practical ways to prepare your body and mind

It’s an introduction to what you get with Unmedicated Academy, and it’s completely free.

You’ll walk away more informed, more grounded, and more confident, no matter what kind of birth you’re planning.

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