After a baby is born, labor isn’t over. The placenta that fed the baby during pregnancy now needs to be pushed out along with the rest of the umbilical cord. This process is called the third stage of labor. Women may get to choose from having a third stage that is physiological or actively managed. The physiological one means delivering the placenta naturally. With an actively managed third stage, your doctor or midwife will give you an injection for your placenta in the thigh immediately after baby is born, or once the shoulders are out but before the cord has been cut. With hospital births, it is common to have a third stage that is managed.

Who Needs Injection for Placenta Delivery?

You may be advised to have a managed third stage of labor if you have had a complicated pregnancy, are at risk of bleeding or have delivered three or more babies already. You should have an injection in the following conditions:

• Pregnancy or labor that has heavy bleeding
• Pregnant with twins
• Polyhydramnios or conditions that cause an over-stretched womb
• History of retained placenta or heavy bleeding
• Anemia
• A placenta that is low-lying
• A labor that is very long or very fast
• Labor that is induced or uses synthetic hormones
• Birth by caesarean or assistance

If you have any questions or concerns about whether to choose a managed third stage labor, you should speak with your doctor.

How Does Injection for Placenta Delivery Work?

• Commonly a woman is given Syntocinon when her third stage of labor is actively managed. With the use of Syntocinon, the uterus will continue contracting after the baby is born. This will help the placenta come away from the uterine wall. Additionally, Syntocinon will help stop bleeding from the woman’s womb, which can help with postpartum hemorrhage prevention.
• Another drug is Syntometrine. This is a little different from Syntocinon and used only if the woman has an increased risk of a postpartum hemorrhage or when the Syntocinon isn’t working.

Advantages

Third stage of labor that is managed tends to be quicker. It don’t require you to push unless you feels the need. With your uterus contracting, your doctor or midwife will gently push on your stomach while pulling the umbilical cord. A decreased risk of heavy bleeding immediately after birth is main advantage of having an injection. In addition, it will be less likely for the mother to become anemic after delivery.

Disadvantages

However, there are a few disadvantages for a mother who opts for a managed third stage of labor:

• Once an injection for placenta has been administered, a mother may feel faint, sick or have a headache. In some cases, she may be unable to hold her baby or vomit because of how sick she feels. Estimates are between 1 in 8 and 1 in 3 for those who will experience these side effects. Some women see significant blood pressure changes.
• Some think there is a higher risk for the placenta to be stuck in the uterus. If this happens, it will need to be removed by an operation.
• It is common practice to give the injection as the shoulders emerge. But it doesn’t have to be given that quickly. If the cord gets clamped before it stops pulsing, the infant won’t get the benefits that come from a natural third stage of birth. It has been shown that early cord clamping can increase the risk of an infant becoming anemic. Additionally, the blood from the cord and placenta is heavily oxygenated and helps the babies while they establish breathing on their own. Moreover, this blood is full of stem cells, which may play a key role in recovery from birth.

Other Mothers' Experience

“I got the injection for placenta with my two labors. With me, I didn’t want to labor over a placenta, I was tired and ready for it to be over. With my first, who was a forceps delivery, I bled like a heavy period for several weeks. Now with this one, I’m bleeding lighter and it’s only been five days. I was up and showering shortly after birth, which felt amazing. I easily recommend it, though you can decide. Remember, it can depend on how you feel, how your labor is and if you’re exhausted.”

“My iron was low leading up to labor, so I had the injection. My OB also recommended it because I had a D&C just a year ago when I lost quite a bit blood during the procedure. For me personally, the injection was safer. I’m undecided on what I’ll do with this pregnancy and still need to meet with my midwife to discuss it.”

“I had wanted a natural labor with my firstborn. The birth and labor ended up being long and I was wiped. A short while later, I had the injection in my thigh and I was surprised that I was scared of a needle after delivering my baby. After a short bit, the placenta came out. I do remember vomiting, but I’m not sure if it was from the injection or hearing how big she was. With my second baby, I don’t remember what happened after birth, but I think I had the injection. I felt great and showered just a few minutes afterward. My midwife was shocked.”