What to Expect During a Placenta Delivery in a Vaginal or a Cesarean Birth?

For new mothers, the process of labor and delivery is full of anxiety. Most believe that once the baby has been delivered, the hard work is over. However, most mothers-to-be often forget that after the baby has been delivered, the placenta also needs to be delivered. Many refer to this as the third stage of labor or the placenta delivery. The placenta has been at the center stage of your pregnancy, providing your baby with nourishment throughout the nine months. Once the baby is delivered, it is important that the entire placenta is also delivered otherwise it may have an impact on a woman’s health. If the placenta or part of the placenta gets retained, then it can cause many side effects, including bleeding. This is why it is important to know what you should expect in a placenta delivery. Let’s take a look.

The placenta is responsible for serving many functions during the growth of your baby.^{(1, 3)} Shaped like a disk, the placenta is attached to one side of the uterus from one end and to the baby’s umbilical cord on the other end.⁽²⁾ The placenta produces hormones such as progesterone, estrogen, and hCG (human chorionic gonadotropin. The placenta also provides all the nutrition your child needs in utero.

The placenta has two sides and there is a color variation between both sides.⁽⁴⁾ The fetal side of the placenta is almost translucent and shiny in color and the maternal side is found to be dark red in color.⁽⁴⁾

After the placenta has been delivered, the doctor will thoroughly check the placenta to make sure that the coloration on both sides is as it should be and to also ensure that the placenta is intact. If a piece of the placenta gets left behind in the uterus, or if the placenta does not deliver on its own, then there are steps a doctor follows to take it out. Retained pieces of the placenta can cause many side effects as well as bleeding.^{(5, 6)}

During the conventional vaginal delivery, once the baby has been delivered, the uterus continues to contract. These contractions will be mild as compared to the contractions you experience while being in labor.⁽⁷⁾ They should last for about a minute each, and many times women don’t even notice them.⁽⁷⁾ These contractions help the placenta separate from the uterine wall.⁽⁷⁾ The contractions then push the placenta and help it move along through the birth canal, allowing you to push it out.

In some cases, your doctor may ask you to continue pushing or they may also need to press down on your stomach to get the placenta moving.^{(7, 8)} The entire process of placenta delivery is quick and happens within just five minutes of having your baby. However, in some women, it may take some more time.

Most women are so focused on seeing their new baby for the first time that many don’t even notice the placenta being delivered. However, some women may feel or observe a sudden gush of blood following the delivery, followed by the placenta being delivered.

When you deliver through a cesarean section, then your doctor physically removes the placenta from the uterus. This is done just before the incision site in the stomach and uterus is closed up. After the placenta delivery, your doctor is likely to massage the top of the uterus, an area known as fundus, to kick start the contractions which allow the uterus to shrink. Since there is no placenta to be delivered, the uterus does not experience the contractions that take place naturally during a vaginal birth.

If the uterus does not contract and become firm again, then you may need to take certain medications such as Pitocin, which will start the uterine contractions. It has been observed that when a new mother starts breastfeeding a baby right after birth, or even when the baby is placed on the mother’s skin to allow the first skin-to-skin contact, it can cause the uterus to start contracting.

No matter in whichever way the placenta gets delivered, your doctor will still inspect the placenta to ensure it is delivered intact. If a portion of the placenta appears to be missing, then your doctor will conduct an ultrasound of the uterus to check where the broken part is. As mentioned above, excessive bleeding after delivery is often an indication that a part of the placenta is still inside the uterus.

Typically it has been observed that within half-an-hour to an hour of delivering the baby, the placenta should be delivered. If even after an hour the placenta is not delivered or if it is not delivered entirely, the condition is known as the retained placenta.⁽⁹⁾ This can happen due to several reasons:

• A part of the placenta has broken off or remains attached to the uterine wall during delivery.
• The placenta is attached to the uterine wall too tightly.
• The cervix has closed after delivery or the opening of the cervix is too small to allow the placenta to pass through.

When the placenta gets retained inside, it becomes a major health concern since the uterus needs to go back to its original size and has to ‘clamp’ back after the baby has been delivered. When the uterus tightens, the process helps the blood vessels to slowly stop bleeding. However, if the placenta gets retained, the uterus is unable to tighten and it may cause the woman to experience bleeding, or it may even lead to an infection.

While there is no actual risk associated with placenta delivery, complications arise if the placenta gets retained. Retained parts of the placenta can cause excessive bleeding or even cause an infection.⁽⁹⁾ Depending upon the size of the retained portion, your doctor will usually advise for surgery to quickly remove the placenta portions. This has to be done at the earliest to allow the uterus to return back to its original size. However, in certain cases, the placenta stays attached to the uterus and in these cases, a surgical removal becomes impossible. In such situations, your doctor may recommend a hysterectomy or the removal of the uterus in order to take out the placenta.⁽⁹⁾

There are certain risk factors that put some women at a higher risk than other for having a retained placenta. These risk factors include:

• A history of uterine fibroids.⁽⁹⁾
• A history of cesarean delivery.⁽⁹⁾
• A history of having retained placenta in previous pregnancies as well.⁽⁹⁾

If you feel concerned about the retained placenta, then you should talk to your doctor before your delivery to ensure that you have a birth plan in place and that the doctor notifies you once the placenta has been delivered.

The birthing process can be stressful, but it is full of hope and excitement of seeing the new baby. The process of placenta delivery is not a painful one, and most women barely even notice it. It happens quickly after the delivery of the baby and the new mother is typically so focused on the baby that the placenta is delivered without even realizing. However, the important part of placenta delivery is that it gets delivered completely. No part of the placenta should be missing. Your doctor will thoroughly examine the placenta once it has been delivered to ensure that the color is what it’s supposed to be and that no part has been retained.

If you wish to save the placenta, then you need to notify your doctor beforehand so that the delivery team can properly save and store the placenta for you.

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