After the Baby Arrives: Navigating Placenta Delivery Options

The moments after birth are precious—your baby is in your arms, and you’re beginning to bond. 
​But inside your body, an essential process is happening: the birth of the placenta. This stage is crucial for your well-being, and how it unfolds can impact your recovery. Let’s break down what happens naturally and what active management of the placenta means.
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The Physiology of Placental Birth


Before your baby is born, your body is already preparing for the placenta’s birth. The placenta is attached to your uterus and provides oxygen and nutrients to your baby throughout pregnancy. As birth nears, hormonal and structural changes help the placenta separate from the uterus.


After your baby is born, your body releases oxytocin—a powerful hormone that helps the uterus contract. These contractions help expel the placenta and stop the blood vessels where it was attached from bleeding excessively. This natural process is sometimes referred to as a physiological third stage of labor.


However, if the uterus doesn’t contract effectively, postpartum hemorrhage (PPH)—excessive bleeding—can occur. This is where active management may be recommended.



Active Management of the Placenta: What Every Woman Needs to Know


Birth is a remarkable process, but did you know that the most dangerous time for a woman is often after the baby is born? While you’re meeting your newborn for the first time, your body is still doing important work—birthing the placenta and ensuring that you don’t lose too much blood. Let’s explore how this works and what choices you have.


How the Placenta is Born Naturally

Before the baby is even born, your body is preparing to release the placenta. As labor progresses, the hormone oxytocin increases, creating strong contractions that not only help your baby be born but also set the stage for the placenta to separate from your uterus.


After your baby is born, oxytocin continues to flow, helping your uterus contract and expel the placenta while also closing off the blood vessels that supplied it. Ideally, this happens smoothly, without intervention, in what’s called a physiological placental birth.


However, sometimes things don’t go as planned, and that’s where active management comes in.


What is Active Management of the Placenta?


Active management is a medical approach to delivering the placenta, aimed at reducing the risk of postpartum hemorrhage (PPH). It typically involves:
• An injection of synthetic oxytocin (Syntocinon or Pitocin) to stimulate strong contractions.
• Clamping and cutting the umbilical cord after birth.
• Controlled cord traction (CCT)—a practitioner gently pulling on the cord to help deliver the placenta.


This approach is commonly used in hospitals, as it is faster and helps prevent excessive bleeding. However, timing and techniques vary between care providers.


When Things Don’t Go Smoothly


The biggest risk after birth is postpartum hemorrhage (PPH)—excessive bleeding due to ineffective uterine contractions. This can happen for two main reasons:

1. Hormonal factors – If your body isn’t producing enough oxytocin or if your uterus has been exposed to too much synthetic oxytocin during labor (such as in an induction), it may not respond as effectively after birth.

2. Mechanical factors – If something is preventing your uterus from contracting properly, such as a full bladder, large blood clots, or a placenta that hasn’t fully detached.


PPH can happen after vaginal births and cesareans, though it’s more common after a c-section. In some cases, a placenta may remain attached longer than expected (retained placenta), requiring intervention.



Supporting a Natural Placental Birth


If you want to avoid active management and support a natural placental birth, there are key factors to consider:
• Have a physiological birth – The fewer interventions you have, the better your oxytocin response will be.
• Create a calm, undisturbed environment – Dim lights, privacy, and minimal medical interruptions help oxytocin flow.
• Skin-to-skin contact and breastfeeding – These trigger oxytocin release and can help your uterus contract naturally.
• Avoid unnecessary cord clamping or pulling – Waiting for natural signs of placental separation (like a small gush of blood or the cord lengthening) can reduce complications.
• Empty your bladder – A full bladder can prevent your uterus from contracting effectively.


What the Research Says


The debate between expectant (natural) vs. active management has been ongoing for decades. Large-scale reviews suggest that in hospital settings, active management may slightly reduce the risk of severe hemorrhage. However, studies also show that women who birth in environments that support natural physiology (like home births or birth centers with experienced midwives) have lower rates of PPH when they avoid intervention.


One study found that active management increased PPH rates seven to eight times compared to a fully physiological approach.

If you would like to do some research into what would be the best option for you, here are some incredible blogs, podcasts and links. 

https://open.spotify.com/episode/7JdBUHN3fJoriag9JQKpZe?si=xcQVMKFVTRuaYR2XgTth8g

https://open.spotify.com/episode/5rUyaVnWu7p1MLDZRHp9sd?si=4U1W2k1BQdKg9INB1KGQ9A

https://open.spotify.com/episode/1aZjL29rWzeYPyp4R8rg6X?si=5iLlm2zAQpupv7X1rc5aQw

https://open.spotify.com/episode/2ncznHyr3ALSisIkqL6npN?si=kgmpUcxRS-eATs2VWlAkQA

https://www.rachelreed.website/blog/active-management-placenta

https://www.rachelreed.website/blog/cord-blood-collection

https://www.rachelreed.website/blog/placenta-resuscitation

https://evidencebasedbirth.com/evidence-on-pitocin-during-the-third-stage-of-labor/

https://evidencebasedbirth.com/wp-content/uploads/2020/06/Pitocin-Handout.pdf
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