27/10/2026
Someone asked me in class recently whether they needed to include anything about the placenta in their birth plan, and the answer is yes, it’s definitely worth thinking about.
Once your baby is born, labour isn’t actually finished. There is still the third stage of labour, which is the time between your baby being born and the placenta being born.
Broadly, there are two ways this stage can be managed.
With an active third stage, you’re given a uterotonic medicine to help the uterus contract, and once the placenta has separated, the midwife uses controlled cord traction to help deliver it.
With a physiological third stage, there is no routine medication. You wait for your own hormones and contractions to separate the placenta, and you usually push it out yourself.
There are pros and cons to both.
Active management tends to be quicker and reduces the risk of heavy bleeding after birth. Physiological management avoids routine medication and lets the process happen without intervention, but it can take longer.
Thiis is why I think it belongs in birth planning. Not because you need to decide something at 34 weeks and then stick rigidly to it no matter what happens, but because it is much easier to make a decision during labour if you have already thought about the options, understood the benefits and drawbacks, and know what might make you change your mind.
You might plan a physiological third stage and then decide you want active management. Or your midwife or doctor may recommend active management if your risk of bleeding is higher, if you start bleeding heavily, or if the placenta is taking longer to come away.
So when you’re writing your birth preferences, don’t stop at “then my baby is born.” Think about what you’d like to happen with the placenta too.
Birth planning isn’t about predicting exactly what will happen. It’s about knowing your options before you need them.