The third and fourth stages of labour

By Nancy Levy, RN, MS on April 10, 2008

THIRD STAGE – 5 to 30 minutes

During the third stage of labour, the placenta is born.

You may:

  • Need a few minutes to collect yourself before focusing on your baby.
  • Be surprised by the baby’s appearance – the body a bloody, greyish-purple colour, covered with a white substance (vernix), the irregular-shaped head.
  • Be engrossed with your baby; be emotional, overwhelmed and cry.
  • Not notice the birth of placenta. 

In Your Body:

  • The uterus contracts to enable the placenta to come away the from uterine wall. Contractions may be mildly painful.
  • The placenta usually slips out in one to two pushes.
  • The uterus contracts against exposed blood vessels from the former site of the placenta site to control bleeding.

The medical staff/midwife may:

  • Ask you to push for birthing the placenta at the appropriate time.
  • Invite your partner to cut the umbilical cord. Some believe the cord should be cut immediately, and others prefer to wait until it stops pulsating.
  • Check baby’s condition immediately and evaluate it at one to five minutes after the birth to give the baby an Apgar score.
  • Give the baby a Vitamin K injection to facilitate blood clotting.
  • Dry and wrap baby to keep it warm.
  • Give you a pitocin injection in your thigh (or through IV). This is a precautionary measure against excessive uterine bleeding.
  • Examine the placenta and umbilical cord to make sure they appear normal.
  • Take routine blood samples from the umbilical cord.
  • Repair episiotomy incision, if applicable; repair tears if necessary (small tears are left alone).

FOURTH STAGE – first hours after the birth

You may:

  • Be hungry, feel tired, elated and satisfied.
  • Be mildly uncomfortable if an episiotomy has been performed.

Your baby may:

  • Open her eyes and be alert and attentive to its parents (the ‘first period of reactivity’).

The medical staff/midwife may:

  • Encourage the baby to breastfeed; this helps control uterine bleeding. Also, if the baby is breastfed within two hours after birth, it is more likely to breastfeed successfully in the coming weeks.
  • Check the height and tightness of the uterus, vaginal bleeding and blood pressure.
  • Put antibiotic ointment in baby’s eyes. (This can be delayed for an hour to allow the baby’s first glimpse of her parents.)
  • Leave the new family alone for most of the first hour together. Every labour and birth is different. Your labour and birth may not proceed exactly as described – especially with regard to the timing of each stage.


No matter what kind of labour you have, congratulate yourself for your hard work – and the miraculous result.

By Nancy Levy, RN, MS| April 10, 2008

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