Third Stage: The Delivery of the Placenta The delivery of the placenta, or the afterbirth, is often overshadowed by the great excitement of the arrival of your new baby into the world. However, delivering the placenta (known as the third stage of labor) remains an important part of your birth experience. The placenta is an amazing organ that nourishes your baby while it is growing in your uterus. For nine months it serves as your baby's lungs and kidneys. It contains many thousands of vessels that filter in nutrients and oxygen from your blood and filter out byproducts of metabolism and carbon dioxide from the baby's blood. Immediately after your baby is born, he or she is still connected to the placenta inside your uterus by the umbilical cord. Evidence suggests, and we believe, it's best to delay cutting the cord until the placenta has stopped pulsating oxygenated blood to your baby, which is usually about a minute or two. Once the blood has stopped pulsating we will clamp the cord. Unless the baby requires immediate medical care, our standard practice is to ask the birthing mother's partner to do the honors of cutting the cord! While you and your baby are spending those first precious moments together, your midwife will be watching for signs that your placenta has separated from the wall of the uterus and is ready to come out. This can take up to 30 minutes but usually takes less than 10 minutes. When your placenta is ready to be born, your midwife will usually exert gentle traction on the cord and may ask you to bear down. After the placenta is delivered, the midwife may massage your uterus to make sure it is becoming firm. This helps prevent excessive bleeding. If massage alone is not enough to stop the flow of blood, the midwife may use medication to help with the process. This is called 'active management of the third stage.' Many studies have shown that actively managing the third stage helps to reduce blood loss and prevent hemorrhage after birth. After it is delivered, your midwife will inspect the placenta to make sure it looks healthy and intact. A healthy placenta has its glistening membranes (or "bag of waters") and strong umbilical cord attached. Beneath its shiny, silvery surface, blood vessels branch out from where the cord is attached. Because of its appearance, many have called it the 'tree of life." Your midwife will usually offer to show the placenta to you and your partner. This is your chance to see the amazing organ that has been keeping your baby healthy inside of you for the last 9 months! References: Brucker MC. (2001) Management of the third stage of labor: an evidence-based approach. J Midwifery Womens Health; 46(6): 381-92. ICM and IFGO. (2003) Joint Statement: management of the third stage of labor to prevent post-partum hemorrhage. Hutton and Hassan. (2007) Systematic review and meta-analysis of controlled trials early versus late cord clamping. JAMA. Rogers et al. (1998). Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial. Lancet; 351(9104):693-9.