Giving birth to the placenta happens after your baby has been born. There are two approaches to this: physiological or active management.

Active management is where we give you an injection to help the placenta come out of your uterus, we clamp and cut the cord after approximately two minutes and we pull gently on the cord to encourage the placenta to be born quickly. We recommend this to reduce excessive bleeding after birth.

Physiological management is where we don’t use drugs, we only clamp the cord after it has stopped pulsating or if the placenta has been delivered. The placenta is delivered by your effort rather than us guiding it out.

Choosing active vs physiological management

You are less likely to have a post-partum haemorrhage (big bleed after birth) when we do active management compared to physiological management. You are also less likely to need a blood transfusion, become anaemic, or need more uterotonic drugs to help. However, you are more likely to feel sick, be sick, have a headache, have high blood pressure, and come back to hospital with bleeding.

If your placenta doesn’t come out or it is taking too long, we can give you drugs to help it be born, empty your bladder and perform a vaginal examination. It this does not work; we will need to transfer you to a surgical theatre for a procedure to take your placenta out of your uterus. If you are not in a doctor-led unit, this will mean transferring you to one.

References:

Intrapartum care. NICE guidelines Published September 29, 2023. Accessed October 18, 2023. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations#planning-place-of-birth