The placenta is a vital organ that plays an essential role in pregnancy, providing oxygen, nutrients, and waste removal between the mother and the developing fetus. Once the baby is delivered, the placenta has completed its function, and the next step is the delivery of the placenta, known as the third stage of labor. This part of childbirth involves the separation and removal of the placenta from the mother’s uterus. The process of placental delivery, its importance, and potential complications are essential considerations in ensuring maternal health after childbirth.
This article will explore whether doctors remove the placenta after birth, the different methods used, the potential complications involved, and what happens to the placenta afterward.
What Is the Placenta?
The Role of the Placenta in Pregnancy
The placenta is an organ that forms in the uterus during pregnancy, attaching to the uterine wall and connecting to the fetus via the umbilical cord. It plays a critical role in supporting fetal development by providing oxygen and nutrients from the mother’s bloodstream and removing waste products from the baby. The placenta also produces essential hormones such as progesterone, which help maintain the pregnancy and prepare the mother’s body for breastfeeding.
As the pregnancy progresses, the placenta grows and changes to meet the needs of the growing baby, typically weighing about 500 grams (1 pound) by the time of delivery. After childbirth, the placenta’s job is done, and it must be expelled from the mother’s body.
The Third Stage of Labor: Placental Delivery
Labor is divided into three stages:
- First Stage: Labor contractions and dilation of the cervix.
- Second Stage: Delivery of the baby.
- Third Stage: Delivery of the placenta, also called “afterbirth.”
Once the baby is born, the third stage of labor begins, during which the uterus continues to contract to expel the placenta and the remaining amniotic sac. The placenta separates from the uterine wall and is passed through the birth canal.
How Is the Placenta Delivered?
Two Methods of Placental Delivery
There are two main ways the placenta is delivered after childbirth:
- Active Management of the Third Stage of Labor
- Expectant (Physiological) Management
Both methods aim to ensure the complete expulsion of the placenta, but they differ in approach.
Active Management
Active management of the third stage of labor involves medical intervention to speed up the process of placental delivery and reduce the risk of complications such as postpartum hemorrhage (excessive bleeding). The key components of active management include:
Administration of Uterotonic Drugs: After the baby is delivered, the doctor or midwife typically administers an injection of a uterotonic drug, such as oxytocin. Oxytocin stimulates the uterus to contract more effectively, helping the placenta detach from the uterine wall and reducing the risk of excessive bleeding.
Controlled Cord Traction (CCT): Once the uterus contracts and the placenta begins to detach, the healthcare provider gently applies traction to the umbilical cord to help guide the placenta out of the birth canal. This process usually takes 5 to 15 minutes.
Uterine Massage: After the placenta is delivered, the doctor or midwife may massage the uterus through the abdomen to encourage it to contract further and expel any remaining blood or clots.
Expectant (Physiological) Management
Expectant or physiological management involves allowing the placenta to be delivered naturally without medical intervention. In this approach, the healthcare provider waits for the mother’s body to expel the placenta on its own. This method relies on natural uterine contractions to detach and deliver the placenta, a process that may take anywhere from 10 minutes to an hour after the baby is born.
With expectant management, the umbilical cord is not clamped and cut until after the placenta is delivered. The mother may be encouraged to push as she did during the second stage of labor to help expel the placenta. In most cases, expectant management is used when there is no indication of complications or increased risk of bleeding.
What Happens If the Placenta Is Not Delivered Naturally?
Retained Placenta
In some cases, the placenta does not detach or is only partially expelled after childbirth. This condition is known as retained placenta, and it occurs in about 0.5% to 3% of vaginal deliveries. A retained placenta can lead to serious complications, including heavy bleeding (postpartum hemorrhage), infection, or uterine damage.
A placenta may be retained for a few reasons:
Placenta Adherens: The placenta remains loosely attached to the uterine wall because the uterus does not contract sufficiently.
Trapped Placenta: The placenta separates from the uterine wall but becomes trapped behind a partially closed cervix.
Placenta Accreta: In more severe cases, the placenta grows too deeply into the uterine wall and does not detach as expected. This condition can lead to complications that may require surgical intervention.
Manual Removal of the Placenta
If the placenta is retained, doctors may need to manually remove it to prevent complications. Manual removal involves the healthcare provider reaching into the uterus through the vagina to gently detach and extract the placenta. This procedure is typically done under local or general anesthesia to manage pain and prevent discomfort.
In rare cases where manual removal is not possible or safe, surgical procedures such as dilation and curettage (D&C) or even a hysterectomy (removal of the uterus) may be required, especially in cases of placenta accreta.
Potential Complications of Placental Delivery
Postpartum Hemorrhage (PPH)
One of the most significant risks associated with the delivery of the placenta is postpartum hemorrhage, which refers to excessive bleeding after childbirth. PPH can occur if the uterus does not contract properly after the placenta is delivered, leading to continued bleeding from the site where the placenta was attached.
Active management of the third stage of labor, including the use of uterotonic drugs and controlled cord traction, has been shown to reduce the risk of PPH. However, in cases where PPH occurs, immediate medical intervention, such as uterine massage, medication, or even surgery, may be necessary to stop the bleeding.
Infections
Another potential complication is infection, particularly if any part of the placenta or membranes is left inside the uterus. This condition is known as retained products of conception (RPOC) and can lead to postpartum infections, characterized by fever, abdominal pain, and foul-smelling vaginal discharge.
In such cases, a doctor may perform a D&C to remove the remaining tissue and prevent infection. Antibiotics are also typically prescribed to treat any infection that has developed.
What Happens to the Placenta After Delivery?
Placenta Disposal and Cultural Practices
After the placenta is delivered, it is typically examined by the healthcare provider to ensure it is intact and healthy. If there are any signs of abnormalities, such as calcifications, clots, or tissue left inside the uterus, additional steps may be taken to address potential complications.
In most cases, the placenta is considered medical waste and is disposed of by the hospital. However, in some cultures and traditions, the placenta holds significant symbolic or spiritual value, and families may request to take the placenta home for specific ceremonies or practices. Common cultural practices include:
Placentophagy: Some people believe in the practice of consuming the placenta, either raw, cooked, or in encapsulated form, based on the belief that it can offer health benefits, such as increased energy and reduced postpartum depression. However, there is limited scientific evidence to support these claims, and healthcare providers generally do not recommend placentophagy.
Placenta Burial: In many cultures, burying the placenta is seen as a way to honor the connection between the baby and the earth. Some families plant a tree or other symbolic object over the buried placenta to celebrate new life.
Medical Uses for the Placenta
In certain cases, placental tissue may be used for medical research or donated for therapeutic purposes. Placental tissue contains stem cells, which have the potential to treat a variety of conditions, including blood disorders, immune system diseases, and certain cancers. Donation of placental tissue for medical purposes can contribute to important advancements in healthcare and treatment options.
Conclusion
The placenta plays a crucial role throughout pregnancy, ensuring the healthy development of the fetus by providing vital nutrients and oxygen. After childbirth, the placenta must be delivered to complete the birthing process. Doctors assist with placental delivery in several ways, depending on the management approach chosen for the third stage of labor. Active management with the use of uterotonic drugs and controlled cord traction is common practice to prevent complications such as postpartum hemorrhage.
In cases where the placenta does not naturally detach, doctors may need to manually remove it to prevent further complications. Regardless of the method of delivery, ensuring the complete expulsion of the placenta is critical to promoting the mother’s recovery after childbirth. Once delivered, the placenta may be disposed of or used for cultural, spiritual, or medical purposes, depending on individual preferences and practices.
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