Within the first hour after your baby is born, you will also need to birth your placenta. This is usually much less effort than birthing your baby!
There are two ways that birthing your placenta can be managed – either physiologically or actively. In general, if you have had interventions in the course of your labour, or you have complications in your pregnancy, active management is recommended. If you have not had any interventions and had a low risk pregnancy, then you can choose which option you prefer. If you are bleeding more than expected, then active management may be advised.
Physiological management involves waiting for the physiological separation of the placenta, and then pushing it out using the same pushing technique as you used for pushing the baby out. It can take up to an hour for this to occur, and can be encouraged by breastfeeding your baby.
Active management involves an injection of synthetic oxytocin either through your IV cannula if you have one, or into the muscle of your arm or thigh. This increases the force of contractions and can encourage the placenta to separate faster. It is usually followed by controlled cord traction, which is where your midwife or doctor gently pulls on the cord to encourage the birth of the placenta. While they do this they will also put pressure just above your pubic bone to ‘guard’ your uterus.