What occurs in Stage 3 of labor?

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Labour has three stages:

The first stage of labour: dilation

Before labour starts, your cervix is long and firm. During the first hours of labour, the muscles of the uterus (womb) contract and help shorten and soften the cervix, so that it can dilate (open).

For first-time mothers, this stage can last from six to 36 hours.

During this time you might experience:

• Contractions - some can be quite mild, like a period pain; others can be sharp and strong. Initially, the contractions will be short (between 30 to 40 seconds) and irregular. Once contractions are five minutes apart and a minute or more in length, labour is said to be 'established'.

• A 'show' - the discharge of a plug of mucus that can be thick and stringy or blood-tinged. This may happen the day you go into labour, or up to a week before.
• 'Breaking of your waters' - this means the amniotic sac around your baby has ruptured.

Every labour is different. If you think you could be in labour, the first thing to do is relax and stay calm. The best place for early labour is at home.

When women who are planning to birth in a primary maternity unit or hospital stay at home until their labour is established, they are less likely to have interventions in their labour and are more likely to have a normal birth. 

Keeping yourself comfortable and supporting your labour to establish while you're at home.

Click here for information on things to do and try and home, and how to look after yourself during early labour. [PDF, 1.1 MB]

When to ring your lead maternity carer (LMC) or our Labour & Birthing Suite (if you are giving birth at Auckland City Hospital):

• Your contractions are coming every five minutes, lasting longer than 50 seconds and have been getting stronger for at least two to three hours.
• You have severe or constant abdominal pain with a tight abdomen.
• Your water has broken and it is clear or has a tinge of pink. Put on a sanitary pad and check it after an hour. If it is wet, please ring us.
• Your water has broken and it is green or brown. Call us immediately - you will be advised to come into hospital.
• If there is a change in the pattern of your baby's movements..
• You notice any vaginal bleeding - bright red vaginal bleeding is not normal.

Things to do and try at hospital:

• Try not to tense up during contractions. Your body is trying to release something, not tighten up.
• Find positions that feel comfortable. Walk the corridors slowly, lean on the walls, use the Swiss ball and La-Z-boy chairs. Try to stay off the bed, unless for a short rest.
• Water is great for relaxation and coping with contractions. If you don't have use of a pool, try the shower.
• Bring music and a player, if it relaxes or calms you.
• Bring an electric oil burner and use your aromatherapy oil.
• Continue to take refreshments and drink small amounts frequently.
• Phone calls are a distraction from your tasks of giving birth and looking after your new baby. Encourage family and friends to phone one designated person for updates.

The second stage of labour: your baby

The second stage of labour begins when the cervix is fully dilated (open) and the baby's head moves down out of the uterus and into the vagina (or birth canal). Your job at this stage is to push the baby through the birth canal, so you'll need focused determination and energy.

The birth of your baby may take 30 minutes to an hour or longer. This second stage could be further extended if you have an epidural.

A small number of women will require assistance with their births, either by forceps or ventouse (vacuum extraction). The obstetrician will choose which is best for your situation.

Find out more about your pain relief options and coping with labour.

The third stage of labour: the placenta

The final stage of labour is delivery of the placenta. There can happen in one of two ways listed below.

Your LMC can help you to decide which approach would be best for you, taking into considering your health, how your pregnancy has progressed and the type of labour and birth you experience.

1. Physiological management

Physiological third stage means waiting for your placenta to deliver spontaneously with your effort. This may take up to an hour following the birth; while you're waiting, skin-to-skin with your baby and a first breastfeed will be encouraged.

2. Active management

Active management involves injecting an ecbolic (contracting drug) into your leg as your baby's shoulders are born. The ecbolic speeds up placental separation and your uterus (womb) contracts down to reduce blood loss and ensure your womb remains contracted.  

Please read our leaflet on caring for your whenua [PDF, 1 MB] for more information.

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After the birth of your baby, your uterus gently contracts to loosen and push out the placenta. This may occur five to 30 minutes after the birth of your baby.

The muscles of the uterus continue to contract to stop the bleeding. This process is always associated with a moderate blood loss – up to 500 millilitres. In this stage of labour, one of the potential problems is excessive bleeding (postpartum haemorrhage), which can result in anaemia and fatigue. This is why the third stage is carefully supervised.

There are two approaches to managing the third stage:

• natural (also known as physiological or expectant) management, or
• active management.

Natural third stage

What is a natural third stage?

A physiological or natural third stage means that you wait for the placenta to be delivered naturally.

After your baby's birth, your midwife will delay clamping the umbilical cord to allow oxygenated blood to pulse from the placenta to your baby.

Your uterus (womb) will contract, and the placenta will peel away from the wall of your uterus. The placenta will then drop down into your vagina, ready for you to push it out.

Delayed cord clamping

For baby

The benefits of delayed cord clamping for the baby include a normal, healthy blood volume for the transition to life outside the womb; and a full count of red blood cells, stem cells and immune cells which results in higher iron stores in the baby for up to six months.

For mother

Delayed clamping keeps the mother-baby unit intact and can prevent complications with delivering the placenta.

Active (or managed) third stage

Benefits of an active third stage

The advantage of an active third stage is the lower risk of very heavy bleeding immediately after the birth. Your midwife or doctor will recommend you have an active third stage if you had complications during pregnancy or labour, such as:

• twin pregnancy
• polyhydramnios
• heavy bleeding during pregnancy or in labour
• a history of retained placenta
• a low-lying placenta
• anaemia
• an induced or very long labour
• an assisted birth or caesarean birth.

Active third stage

Immediately after the birth of your baby, the midwife or doctor gives you (with your consent) an injection of oxytocin, clamps and cuts the umbilical cord, and then carefully pulls on the cord to speed up delivery of the placenta.

Modified active third stage

This is a combination of active and natural. It is similar to active third stage but it includes delayed cord clamping.

The third stage of labour begins when your baby is born. During this stage of labour, the placenta and membranes that supported your baby in your uterus come out through your vagina.

Your midwife can help this to happen by guiding the placenta out and by giving you an injection to help your uterus contract. This is called ‘active management’. Some women prefer to deliver their placenta without medical help. This is called 'physiological management'. It is a good idea to discuss your preferences with your healthcare team during your pregnancy and before the birth.

During the third stage of labour, the umbilical cord, which connected your baby to your placenta, is clamped and cut. If you would like the umbilical cord to be left intact, or to be clamped later, you should let your midwife know so that they can arrange this. If your birth partner would like to cut the cord, let your midwife know. You may also like to add this to your birth plan, if you have one.

How long does it usually last?

The third stage of labour generally lasts about 30 minutes if actively managed. If you decide to use physiological management, meaning that you deliver the placenta without medication or hands-on help from your midwife, the third stage can take up to one hour.

What can I do to help the placenta come out?

You may choose to change positions to help the placenta come out. Pushing gently will also help the placenta come out. You may experience mild contractions as the placenta comes away from your uterus.

How can my midwife support the third stage of labour?

If you are actively managing the third stage of labour, your midwife will offer you an injection of a medicine called oxytocin. This helps your uterus to contract after birth. This medicine is used to reduce the risk of excessive bleeding (post-partum haemorrhage), and to reduce the risk of needing a blood transfusion after birth.

Your midwife will support you by checking the position of your uterus and by gently pulling on the umbilical cord when they notice signs that your placenta is ready to come out.

When the placenta begins to come out through your vagina, your midwife will guide the placenta, while gently twisting to make sure all of the membranes come out with it.

Your midwife will also clamp and cut the umbilical cord. This is generally done a few minutes after your baby is born, and after the blood in the umbilical cord has had time to flow into your baby. In some situations, your doctor or midwife may recommend clamping and cutting the umbilical cord immediately after birth. This is usually only needed if you or your baby are very unwell.

Women have different preferences regarding when the umbilical cord should be cut and what should be done with the placenta after delivery. Your health team will do all they can to facilitate and support your decisions, while keeping the health of you and your baby as a top priority.

Do I need stitches after labour?

After your placenta has come out, your midwife will check the skin around your vagina (your perineum) for tears. Your skin can sometimes tear when it is stretched during birth. Your midwife will check if you have a tear and if so, how deep the tearing is and where it is located. Small, shallow tears may not need to be closed with stitches. However, larger tears should be treated to make sure that they heal properly and to reduce your chance of complications afterwards. If you need stitches, your doctor or midwife will offer you medicine for pain relief before you get them. If you have had an episiotomy, this will also need stitches.

Will my birth partner be with me?

Your birth partner can stay with you throughout this stage of labour if you would like them to be. They will be able to support you, for example by reassuring you and bringing you anything you need. If you would prefer that your birth partner is not with you during any part of your labour, let your midwife know — it’s your choice.

Where is my baby during the third stage of labour?

Your baby will be placed on your chest or stomach after they are born, with their skin directly in contact with yours. This is called ’skin-to-skin’ contact and it is your first opportunity to hold and cuddle your new baby. Your midwife will cover you both with a blanket to keep you warm. They will also check on you and your baby to make sure you are both doing well. Your midwife will need to measure your baby and give them medicines, but there is no rush. This time is for you to meet your baby and enjoy being with them.

This is also a good opportunity to breastfeed your baby for the first time if you would like to. Breastfeeding can shorten the third stage of labour and reduce the amount of bleeding you experience. This is because breastfeeding causes your body to release oxytocin, which naturally contracts your uterus. Your midwife will show you how to breastfeed your baby if you would like them to. You can breastfeed your baby right after birth (even if you plan to bottle feed later). Some women find that this a great way to start to bond with their newborn.

What happens if something goes wrong?

Every labour is unique, and sometimes things don’t go according to plan. You may have to adjust your birth plan if the situation calls for it. There can be labour complications in which extra medical support is needed. Your midwife will communicate with you and your doctor to guide you to make the best decisions for you and your baby.

Listen to our podcast on understanding your choices when having a baby.

Last reviewed: February 2022