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The Third Stage of Labour - What You Need to Know

Updated: May 11, 2023

Baby attached to placenta

When we talk about birth we talk about the 3 stages of labour: stage 1 is the dilation stage, when your cervix is drawing up and opening to allow baby out. Stage 2 is the ‘pushing’ stage – although in hypnobirthing we encourage breathing the baby out rather than forced pushing. Stage 3 is birthing your placenta – a stage which so often gets forgotten about until the time. There are two options when it comes to stage 3; an actively managed stage which sees Mum being given an injection to hurry up the detaching and birth of her placenta, or physiological which means waiting for Mums body to contract again and to birth the placenta naturally.

There are benefits and risks of both stages, which is what I want to highlight in this post. It is a very personal choice (as is every decision throughout pregnancy and labour) so please do your research before deciding which option is best for you.


‘Active management’ or a ‘managed third stage’ means that once your baby is born you have an injection in your thigh (usually called Syntometrine which is a combination of syntocinon) to make your uterus contract strongly in order to push out the placenta quickly. It also makes your uterus then clamp down in order to reduce bleeding once the placenta has been delivered.


  • The third stage is over quickly

  • Average blood loss is lower

  • Mum doesn’t have to actually ‘do’ anything, just wait and the drugs and midwives will do the work


  • Some women report feeling dizzy, sick or faint or that they have a headache after having the injection

  • Can cause changes to blood pressure in some women

  • There is thought to be a higher risk of a trapped placenta. Basically if the placenta hasn’t been delivered before the uterus clamps down this can cause it to be trapped. This would need to be manually removed in an operating theatre. However, the risk of this is low.


‘Physiological’ or a ‘natural’ third stage means no drugs are given to speed up the delivery of the placenta and you wait for the placenta to be delivered naturally. If, at any stage, the blood loss appears to be getting too high or you decide you have waited long enough you can have a managed third stage.


  • No need for drugs to be used

  • No risk of side effects such as dizziness, feeling sick or faint


  • Can take longer, although research has shown that a physiological stage takes only 9.7 minutes longer than active management. However can take up to an hour or more

  • Average blood loss is higher – although the figure is still small and not a huge difference


The main difference between an actively managed third stage and a physiological third stage is that if delivering the placenta naturally you have to be actively involved in the process. You have to push it out yourself and sometimes this means you might need to move around and change positions, although often all that is required is for you to stand up and the placenta will come out. It is important for oxytocin to remain high during the third stage in order to push the placenta out and help the uterus to contract down. So make sure you are keeping the environment the same as the rest of your labour. Low lights, soft voices and nice and calm.

As mentioned already, please do your research around this subject before making a decision. Its very personal and what is right for one person is right for another. Once you have made a decision on how you would like your third stage to be, be sure to write it into your birth preferences so your caregivers are aware of your wants.

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Hypnobirthing and doula Southend
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