# Third Stage — Delivering the Placenta

Source: https://www.pregnancypowerhour.com/birth/third-stage-placenta
Last updated: 2026-07-15

> The third stage of labor involves the delivery of your placenta, a brief but important phase after your baby's birth where you have choices about its management.

The third stage of labor, often discussed less than the first two, is the period immediately following your baby's birth, focused entirely on the delivery of your placenta. While your baby is now in your arms, this stage is a crucial part of the birthing process, typically taking between 5 and 30 minutes. Understanding the options available for this stage can help you feel calm and clear about your preferences, ensuring a confident transition for both you and your newborn.

## What it is

After the powerful work of bringing your baby into the world, your body continues its process by delivering the placenta. This is often a less intense experience than labor contractions, as the placenta detaches from the uterine wall and is expelled. This stage involves monitoring for signs of placental separation, such as a gush of blood or a lengthening of the umbilical cord, and then the actual delivery. While it's a natural physiological process, there are different approaches to how this stage is managed, each with its own considerations.

## What the evidence says

When it comes to delivering the placenta, the evidence highlights two main approaches: active management and physiological (or expectant) management. Active management typically involves giving a dose of oxytocin shortly after birth, along with controlled cord traction (gently pulling on the umbilical cord) to encourage placental delivery. Research, including findings from Cochrane, indicates that active management significantly reduces the risk of postpartum hemorrhage by approximately 60%, making it one of the most evidence-supported obstetric interventions. This approach is widely practiced in many settings due to its proven benefit in reducing a common and serious complication.

On the other hand, physiological management allows the placenta to deliver naturally, without intervention, relying on the body's own rhythms. This is often an option for low-risk births, particularly within midwifery care. While it offers a less interventional approach, it does carry a slightly higher risk of postpartum hemorrhage compared to active management. Both are valid choices, and understanding the evidence behind each can help you make an informed decision for your birth experience.

Another key evidence-based practice in the third stage is delayed cord clamping. Major organizations like ACOG, WHO, and AAP recommend waiting between 1 and 5 minutes before clamping and cutting the umbilical cord. This practice allows more blood to transfer from the placenta to the newborn, which increases the baby's iron stores. This is considered significant for all babies, and especially beneficial for preterm infants, supporting their early development.

## When it's recommended

Active management is often recommended as a routine practice in many hospitals due to its strong evidence base in reducing postpartum hemorrhage risk. This is particularly true for individuals with risk factors for excessive bleeding. Physiological management might be recommended for those with low-risk pregnancies who prioritize a hands-off approach and are comfortable with a slightly elevated, though still low, risk of hemorrhage. Your care provider will discuss these options with you, considering your individual health profile and preferences. It's always a collaborative conversation to determine what feels right for you.

## Brittany's doula perspective

The third stage of labor, while brief, is a powerful moment that often gets less attention in [childbirth education](/birth/childbirth-education) than the earlier stages. Yet, it's a time when important decisions are made that impact both your health and your baby's. As a doula, I often remind clients that even after your baby is born, your agency and choices remain paramount. You get to decide how your placenta is delivered and when your baby's cord is clamped.

It’s helpful to discuss your preferences for active versus physiological management, as well as delayed cord clamping, with your provider well before your due date. Incorporating these preferences into your [writing a birth plan](/birth/birth-plan) can ensure your wishes are clearly communicated. Remember, your provider is your best resource for your specific situation, and they can help you weigh the options. Having [doula support](/doula-support) can also provide an extra layer of advocacy and information, helping you navigate these conversations with clarity and confidence. If the placenta doesn't deliver within about 30 minutes, it's considered retained, and your provider will discuss interventions like manual removal or surgical options to ensure your safety.