Your birth doesn’t finish when your baby is born – there is the vital third stage of labour to birth your placenta that follows.
As with the first two stages of labour and the birth of your baby, the third stage can be quick, long or somewhere in between.
For many women, little, if any intervention is needed.
Skin to skin and initiating latching can help keep oxytocin flowing, which encourages the release of the placenta naturally.
This is known as a physiological third stage. Some opt to have a managed third stage, which involves the use of a synthetic oxytocin injection to induce uterine contractions to help expel the placenta.
In rare cases, around 0.5-1% of births, retained placenta occurs.
Here are some facts about retained placenta you need to know:
What Is Retained Placenta?
Retained placenta is when the placenta is not expelled within one hour of the vaginal birth of your baby. Retained placenta can also occur when only a part of the placenta is not expelled, or part was not removed during a c-section. This might be noticed when they examine the placenta and find a tear, or notice that it isn't the whole placenta. In rare cases, the retained placenta can go unnoticed until other symptoms arise.
What Causes Retained Placenta?
There isn't always a known cause for each case of retained placenta. There are some factors that can increase the risk of a retained placenta. These include:
- Part of the placenta implanted into a uterine scar
- Premature birth
- Induction or augmentation of labor
- Placental abnormalities such as a lobulated placenta
- Grand parity, which is having more than 5 previous births
If you have any of the risk factors, remember it is simply a risk and not a guarantee of complications. Your provider will likely discuss a managed vs physiological third stage with you and you can think about benefit vs risk for each. They will pay attention during the third stage of your birth.
World famous obstetrician and researcher, Doctor Michel Odent, believes the increase in interventions and the interruption of immediate mother/baby bonding can be linked to complications with the placenta expelling. Routine interruptions with normal physiological birth are not without risks. Sometimes we need interventions, in those situations the benefit outweighs the risk. When not medically indicated, we need to assess the risk of interrupting a natural process.
Retained Placenta Symptoms and Signs
In the case of a fully retained placenta, it's easy to diagnose. As you near an hour post birth and the placenta is nowhere to be seen, you'd be diagnosed with retained placenta. In cases of retaining only fragments of the placenta, it might take time to notice. Some signs and symptoms include:
- Postpartum hemorrhage after the placenta has been birthed
- Foul smelling vaginal discharge
- Painful cramping and contracting
- Examination of the placenta shows possible tears or missing pieces
- Delay in milk production
In cases of missed retained placenta, the typical postpartum ailments and concerns can mask the symptoms. Many new mothers are concerned about low milk supply or a delay in milk production. For most, infant led feeding is all that is necessary to begin adequate milk production. In the case of retained placenta, there is a noticeable delay in milk supply, regardless of ruling out any other potential causes.
Renee Kam, IBCLC, (International Board Certified Lactation Consultant) says, “The detachment of the placenta is the cause of hormonal changes that signal for a mother's milk to ‘come in'. If any of the placenta gets left behind in the uterus, this signal is interrupted and a mother's milk doesn't come in properly.”
Retained Placenta Treatment
If you have a natural (physiological) third stage, and reach an hour without the placenta expelling, your caregiver will likely want to give you an injection of synthetic oxytocin, to encourage the uterus to contract. The contractions should help to expel the placenta. Your provider might try to gently tug and remove the placenta if it appears to have detached from the uterine wall but is not yet expelled.
If the synthetic oxytocin doesn't work, or if there is concerning postpartum hemorrhage, your provider might try another medication. Often though, they will opt for manual removal or a D&C (Dilation & Curettage). These are done with local or general anesthesia.
If you were discharged and the retained placenta goes unnoticed, you might be readmitted for care. If there is concern of infection, your re-admittance would include a procedure to remove the retained pieces, as well as antibiotic IV medication. Some providers will do an outpatient or day procedure to remove the retained placenta, and will send you home with oral antibiotics to prevent or treat any signs of infection.
Can Retained Placenta Be Prevented?
Birth can be unpredictable, so it can be hard to reduce the risk of rare complications. If you had a retained placenta with a previous birth, you will have a higher risk of having another, so your provider will likely pay close attention during the third stage.
When birth is low-risk, the less we interfere with medical interventions, the lower the risk of complications. Keeping mama and baby together, skin-to-skin and undisturbed, may lower the risk of retained placenta. Avoiding unnecessary synthetic oxytocin inductions and augmentations may also reduce the risk, as well as prevent a c-section and subsequent uterine scar. Too much synthetic oxytocin can cause uterine atony, which is when the uterus stops contracting or isn't contracting effectively.
If there are complications, even despite allowing physiological birth, we are fortunate to have access to medical technology. Retained placenta is often easily treated. Choosing a healthcare provider that you truly trust can be invaluable when complications arise. When you trust your midwife or doctor, you can rest assured they are there to help you have a positive birth and can help resolve unexpected complications.