The third stage of labour

The third stage of labour is the delivery of the placenta. For most women and their labour partners, third stage is a lot less interesting than the other stages of labour. But it is part and parcel of the whole process, and sometimes things happen in the third stage that can affect the nature of the whole labour experience, so it's worth thinking about.

In a lot of hospitals, the usual practice is for the syntometrine injection to be offered only once your baby's head and first shoulder have been born, so you'll be asked if it's okay for the injection to be given then. In other hospitals, the procedure might be slightly different, in that you'll be asked beforehand whether you'd like to deliver the placenta with or without the injection.

You may want to find out now what the practice is in your hospital. If you'd prefer not to have the injection, it's a good idea to say so on your birth plan so that the midwife knows in advance. If you're having your baby at home, discuss with your midwife before the birth how you'd like the placenta to be delivered. Because the timing of giving the injection is important, there's not really much opportunity for discussion about whether you'd like to have the injection or not at the point at which it needs to be given - so this really is something that's worth thinking about before the labour.

However you choose to have the placenta delivered, if you'd like the cord to be cut by your labour companion, make sure you let your midwife know in advance. If you don't wish the cord to be clamped until the cord has stopped pulsating, let your midwife know (the cord can't be left to pulsate if syntometrine is given).

What are your options?

Here are some things to consider before making up your mind:

• Do you mind how long the delivery of the placenta will take? Without the injection, it usually takes longer - perhaps up to an hour.
• Would you prefer to have time with your baby without any distractions immediately after he's born? There can be a lot of activity involved if you do have the injection.
• How do you feel about the possibility of losing blood? You will lose blood either way, but if you don't have the injection you're likely to lose a lot of blood (more than 500mls). Remember though, that you have a lot more blood than usual in pregnancy.
• What's best for your baby? There's not much evidence of this - without the injection, baby continues to be supplied with oxygen through the cord while starting to breathe for himself. He also gets blood from the cord, providing it hasn't been clamped.
• Are you concerned about the possible side effects of the injection? It can make you sick, raise your blood pressure or give you a headache.
• Are there particular circumstances in which it's better to have the injection? Yes: they include if you've been anaemic in pregnancy; if you've had any bleeding in pregnancy; if you've had a drip to start or speed up labour; if you've had pain-killing drugs or an epidural; if you've had forceps or ventouse; if you have more than one baby; if you've had a very long labour; and if you have raised blood pressure (though in this case a different type of drug is sometimes used).

Where to next?

• Read more about what happens when having a syntometrine injection
• Want a natural third stage? See what's involved
• Find out more about the delivery of the placenta on our Ask the experts section

Do you have enough information to make up your mind about syntometrine, or would you like more advice? Let me know.

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