Birth isn’t over when your baby arrives — you still have to birth the placenta. Knowing what to expect can help you feel more prepared, informed, and empowered.
This part of a vaginal birth is called the third stage of labor. Many pregnant women aren’t familiar with what’s involved in birthing the placenta because it’s not talked about often — but it should be. So let’s talk about it!
The 3 Stages of Labor
First stage: This is defined as the onset of true labor until the cervix is completely dilated to 10 cm.
Second stage: Known as the pushing stage, this stage begins after the cervix is fully dilated to 10 cm and ends after the baby is born.
Third stage: The final stage (also called the final stage) occurs after the birth of the baby and ends after the placenta is delivered.
Active vs Physiological Management
During a vaginal birth, there are two distinct approaches to the third stage of labor: active (medical) management and physiological (natural) management. Being aware of your options can help you make an informed decision about what’s best for you.
Active Management
Medical approach, provider-led.
Placenta delivery is sped up using uterotonic medication and umbilical cord traction. This is the more common approach in hospital settings, and is often completed within 30 minutes.
This involves:
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An injection of synthetic oxytocin (Pitocin) in the thigh to expel the placenta.
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Early cord clamping and cutting
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Controlled cord traction (CCT)
While applying gentle traction on the cord can assist with delivery of the placenta, applying it too early or forcefully increases the risk of postpartum hemorrhage, especially if the placenta hasn’t yet naturally separated from the uterine wall. This can lead to complications like retained placenta or uterine inversion.
Most hospitals place time limits on the third stage of labor. This typically means 30 minutes for an actively managed third stage, or up to 60 minutes for a physiological third stage. If the placenta hasn’t been delivered within that timeframe, manual removal or other interventions are often initiated.
Physiological Management
Natural approach, mother-led. Also known as expectant management.
The placenta separates and is delivered spontaneously by the mother’s own efforts, without medication or traction. This approach is more common in home birth, midwifery-led care, and physiological birth settings, and can take up to 60 minutes or longer.
This involves:
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No Pitocin (unless medically indicated)
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No traction or pulling on the cord
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Waiting for signs of placental separation (gush of blood, cord lengthening, contractions)
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The mother pushes when ready
Your body’s own oxytocin naturally peaks after an unmedicated birth. Oxytocin is the hormone that strengthens uterine contractions to help separate the placenta from the uterine wall and move it out through the birth canal. Effective uterine contractions prevent postpartum hemorrhage.
There are several ways to boost oxytocin to support this process, including skin-to-skin contact and breastfeeding initiation. Keeping the environment warm, calm, and quiet also allows oxytocin to rise and do its job.
If you’re hoping for a physiological third stage, be sure to choose a care provider who is comfortable and experienced with this approach, and discuss your preferences with them in advance.
