Editing Childbirth (section)

==== Third stage ====
{{Further|Umbilical cord|Placental expulsion}}
The period from just after the fetus is expelled until just after the [[placenta]] is expelled is called the ''third stage of labour'' or the ''involution stage''. [[Placental expulsion]] begins as a physiological separation from the wall of the uterus. The average time from delivery of the baby until complete expulsion of the placenta is estimated to be 10–12 minutes dependent on whether active or expectant management is employed.<ref>{{cite journal | vauthors = Jangsten E, Mattsson LÅ, Lyckestam I, Hellström AL, Berg M | title = A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial | journal = BJOG | volume = 118 | issue = 3 | pages = 362–69 | date = February 2011 | pmid = 21134105 | doi = 10.1111/j.1471-0528.2010.02800.x | display-authors= 4 | doi-access = free }}</ref> In as many as 3% of all vaginal deliveries, the duration of the third stage is longer than 30 minutes and raises concern for [[retained placenta]].<ref>{{cite journal | vauthors = Weeks AD | title = The retained placenta | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 22 | issue = 6 | pages = 1103–17 | date = December 2008 | pmid = 18793876 | doi = 10.1016/j.bpobgyn.2008.07.005 }}</ref>

Placental expulsion can be managed actively or it can be managed expectantly, allowing the placenta to be expelled without medical assistance. Active management is the administration of a [[uterotonic|uterotonic drug]] within one minute of fetal delivery, controlled traction of the [[umbilical cord]] and [[fundal massage]] after delivery of the placenta, followed by performance of uterine massage every 15 minutes for two hours.<ref>{{cite journal | vauthors = Ball H |title= Active management of the third state of labour is rare in some developing countries |url= http://www.guttmacher.org/pubs/journals/3510509.html |journal= International Perspectives on Sexual and Reproductive Health |volume= 35 |issue= 2 |date= June 2009 |url-status= live |archive-url= https://web.archive.org/web/20160304053957/http://www.guttmacher.org/pubs/journals/3510509.html |archive-date= 4 March 2016 }}</ref> Active management of the third stage of labour in vaginal deliveries helps to prevent [[Postpartum bleeding|postpartum haemorrhage]].<ref>{{cite journal | vauthors = Stanton C, Armbruster D, Knight R, Ariawan I, Gbangbade S, Getachew A, Portillo JA, Jarquin D, Marin F, Mfinanga S, Vallecillo J, Johnson H, Sintasath D | title = Use of active management of the third stage of labour in seven developing countries | journal = Bulletin of the World Health Organization | volume = 87 | issue = 3 | pages = 207–15 | date = March 2009 | pmid = 19377717 | pmc = 2654655 | doi = 10.2471/BLT.08.052597 | display-authors= 4 }}</ref><ref>{{cite journal | title = Joint statement: management of the third stage of labour to prevent post-partum haemorrhage | journal = Journal of Midwifery & Women's Health | volume = 49 | issue = 1 | pages = 76–77 | year = 2004 | pmid = 14710151 | doi = 10.1016/j.jmwh.2003.11.005 | author-link1 = International Confederation of Midwives | author-link2 = International Federation of Gynaecology and Obstetrics | author1 = International Confederation of Midwives | author2 = International Federation of Gynaecologists Obstetricians }}</ref><ref>{{Cite report|title= WHO recommendations for the prevention of postpartum haemorrhage |year= 2007 |url= http://whqlibdoc.who.int/hq/2007/WHO_MPS_07.06_eng.pdf |archive-url= https://web.archive.org/web/20090705031910/http://whqlibdoc.who.int/hq/2007/WHO_MPS_07.06_eng.pdf |archive-date= 5 July 2009 | vauthors = Mathai M, Gülmezoglu AM, Hill S |publisher= [[World Health Organization]], Department of Making Pregnancy Safer |location= Geneva}}<!-- updated version available at http://www.who.int/maternal_child_adolescent/documents/postpartum_haemorrge/en/index.html --></ref>

Delaying the clamping of the [[umbilical cord]] for at least one minute or until it ceases to pulsate, which may take several minutes, improves outcomes as long as there is the ability to treat [[jaundice]] if it occurs. For many years it was believed that late cord cutting led to a mother's risk of experiencing significant bleeding after giving birth, called [[postpartum bleeding]]. However, delaying cord cutting in healthy full-term infants results in early [[haemoglobin]] concentration and higher birthweight and increased iron reserves up to six months after birth with no change in the rate of postpartum bleeding.<ref>{{cite journal | vauthors = McDonald SJ, Middleton P, Dowswell T, Morris PS | title = Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD004074 | date = July 2013 | pmid = 23843134 | doi = 10.1002/14651858.CD004074.pub3 | editor1-last = McDonald | editor1-first = Susan J | pmc = 6544813 }}</ref><ref>{{Cite news |last1=Campbell |first1=Denis |name-list-style=vanc |title=Hospitals warned to delay cutting umbilical cords after birth |url=https://www.theguardian.com/society/2013/jul/11/hospitals-nhs-umbilical-cords-babies-delay-cutting |newspaper=The Guardian |access-date=11 June 2018 |date=10 July 2013 |archive-date=12 June 2018 |archive-url=https://web.archive.org/web/20180612145023/https://www.theguardian.com/society/2013/jul/11/hospitals-nhs-umbilical-cords-babies-delay-cutting |url-status=live }}</ref>