How a Placenta Releases
Late in pregnancy, the placenta degrades at a cellular level in preparation for birth and its eventual release. Specific hormones released in labor begin the process of breaking down the placenta prior to release after birth. After a vaginal birth, the uterus continues to contract, which helps physically expel a placenta that usually has been well prepped to release (you will continue having small, mild contractions for up to a couple of weeks after birth in order to shrink down the uterus to its pre-pregnancy size). Also after birth, the blood exchange between the placenta and the baby stops, thereby further helping the separation occur.
How Long After Birth Does the Placenta Come Out?
With a vaginal birth, the placenta is usually ready to come out within 5 minutes but up to 30 minutes after birth (in some situations and with some care providers, an hour is allowed before intervention). During a cesarean, the surgeon will manually remove the placenta after the baby is out and while the uterine incision is still open.
Pushing Out the Placenta
With little to no effort, the placenta will usually slide out of your vagina. In a typical hospital birth, the doctor or midwife may ask you to give a small push during a contraction shortly after birth to push out the placenta. You may even feel an urge to push as the placenta detaches and moves down/out. The placenta can expel without pushing, too. Your care provider will collect and examine the placenta to be sure it is fully intact (in one piece, with no pieces left behind inside your uterus).
Some people don’t feel the placenta coming out. This is especially true for those with an epidural. Some feel an urge to push and describe the feeling of “birthing” the placenta as a relief and much, much, much easier than the baby — more like a small bowel movement. Many describe it as feeling a warm, squishy, mushy, blobby, jelly, or Jello-like mass pass through.
Active vs. Expectant Management – Two Modes of Care for Delivering the Placenta
There are two kind of ways your care provider can “manage” the delivery of your placenta, also known as the third stage of labor. “Active management” involves administering a drug to further help contract the uterus (Pitocin), clamping the umbilical cord early after birth, and using a combination of traction (pulling) on the umbilical cord attached to the uterus along with external pressure (pushing) on the uterus in order to encourage delivery of the placenta earlier. Active management was developed to prevent severe blood loss (hemorrhage), which is especially useful in under-resourced countries where people are more likely to have complications at birth. Active third stage management has become standard in the United States.
“Expectant management” allows the placenta to detach and birth spontaneously with careful observation for any abnormalities or issues. Some providers employ a mixed management style that combines some of both methods. Talk to your care provider to find out how they manage the third stage of labor and discuss any questions/concerns you may have. There are risks and benefits to both styles of management. Learn more in detail here.
Complications Related to the Placenta in the Third Stage of Labor
There are complications/abnormalities involving the placenta that can happen during the third stage, the most known being a retained placenta (when parts or all of the placenta is not released within 30-60 minutes after birth). Retained placenta isn’t common (it happens in 2-3% of all births), but it is a serious complication that requires medical intervention. If parts or all of the placenta remains, it must be removed to prevent hemorrhage and illness.
Retained placenta may be diagnosed immediately or within a short while after birth if it is visually recognized by a care provider that the placenta was not fully intact. If it is not caught after birth, there may be symptoms in the day or days after birth that signal a retained placenta, including fever, persistent heavy bleeding, pain that won’t go away, and foul-smelling discharge along with pieces of tissue. If retained placenta is not diagnosed right away, symptoms can continue and worsen in the days and weeks after birth. Ultrasound is often used to diagnose a missed retained placenta. If you experience any of the above symptoms, contact your care provider right away or go straight to the hospital.
Treatment for retained placenta includes manual (by hand) removal, which can be risky and very painful; administering medication to make the uterus contract to expel the placenta; urinating (if shortly after birth) as a full bladder can make it more difficult for the uterus to release the placenta; or surgery, generally a “D&C” (dilation and curretage) in which the placental tissue is removed. In severe cases of retained placenta accreta (where the placenta grows into the uterine wall), a hysterectomy may be required.
What Happens to Your Placenta After Birth
Some people are eager and curious to see their placenta after birth and may request to do so. Some care providers may even offer to show you. Others are either disinterested or too grossed out. It’s a personal preference! Some opt to take their placenta with them for personal rituals or for ingesting in a variety of ways. If you do not wish to take your placenta with you, the hospital classifies it as biohazard material and will dispose or incinerate it accordingly.