The placenta is a remarkable organ that develops during pregnancy to provide oxygen and nutrition to the growing baby. But what happens to the placenta after the baby is born? Here is an overview of how long the placenta stays in the uterus after birth and when it is delivered.
What is the Placenta?
The placenta is a temporary organ that connects the developing baby to the uterine wall, allowing nutrient uptake, waste elimination, and gas exchange via the mother’s blood supply. The placenta starts developing early in pregnancy and is fully formed by about week 20 of gestation.
The placenta is disc-shaped and measures about 9 inches in diameter and 1 inch thick. It contains blood vessels from the mother and baby that intertwine but do not mix. The placenta filters out certain substances from the mother’s blood while allowing oxygen, nutrients, and hormones like estrogen and progesterone to pass to the baby. It also removes waste products like carbon dioxide from the baby.
How Long Does the Placenta Stay in the Uterus After Birth?
The placenta and umbilical cord are still attached to the newborn immediately after birth. The umbilical cord is then clamped and cut, separating the baby from the placenta. However, the placenta is not immediately expelled from the uterus after the baby is born.
On average, the placenta is delivered within 15-30 minutes after birth, but this timing can vary.
Here’s an overview of when the placenta is typically delivered:
- Vaginal birth: Within 5-30 minutes after delivery of the baby
- C-section: Within 5-15 minutes after delivery of the baby
There are several stages the placenta goes through after the birth before it detaches from the uterine wall and is pushed out of the vagina.
Stage 1: Separation from the Uterine Wall
After the baby is born, contractions of the uterine muscle continue, which allows the placenta to separate from the uterus. This is called placental separation or placental expulsion. The contractions constrict blood vessels that nourish the placenta, which allows it to peel away from the uterus.
Stage 2: Descending Through the Cervix
As the lower edge of the placenta separates, it descends into the cervical opening. At this point, the placenta is still attached inside the uterus but protrudes through the dilated cervix into the vagina.
Stage 3: Expulsion
In the final stage, the placenta is completely expelled from the uterus and out through the vagina. A gush of blood often accompanies this due to arteries rupturing as the placenta detaches. The expelled placenta is round and measures about 9 inches in diameter. The side that faced the uterus is shredded, while the fetal side is smooth.
What Could Delay Delivery of the Placenta?
While most placentas are delivered within 30 minutes after birth, some factors can cause a delay:
- Full bladder: A distended bladder takes up space in the uterus and can prevent effective contractions to expel the placenta. A woman may be asked to urinate before pushing to deliver the placenta.
- Retained placenta fragments: Pieces of placental tissue may remain attached to the uterus, preventing the placenta from detaching normally.
- Uterine atony: The uterus fails to contract after delivery, so the placenta does not detach.
- Placenta accreta: The placenta embeds too deeply into the uterine wall and does not detach easily after birth.
If the placenta has not been delivered within 30 minutes after birth, there may be a concern for a retained placenta. After 30 minutes to 1 hour after delivery, the provider may take steps to manually remove the placenta by gently pulling on the umbilical cord and massaging the uterine fundus.
When to Call a Provider About a Delayed Placenta Delivery
Notify your provider if:
- You have not delivered the placenta within 1 hour after birth.
- You are bleeding very heavily before placental delivery.
- You feel dizzy, lightheaded, or excessively fatigued.
A delayed placental delivery increases the risk of postpartum hemorrhage because blood vessels where the placenta detached continue to bleed until the uterus contracts well. Your provider will assess the situation and may give medication to encourage uterine contraction. In rare cases, operative procedures are needed to remove a retained placenta.
Signs of Placental Delivery
Signs that the placenta has fully detached and is ready for delivery include:
- Uterine contractions intensify.
- Heavy bleeding from the vagina with clots.
- Sudden gush of blood as the placenta detaches from uterine wall.
- Visible umbilical cord descending from the cervical opening.
- Mother feels urge to push.
The provider may gently pull and massage the mother’s lower abdomen to aid delivery if needed. However, forceful traction of the cord should be avoided as this can cause the placenta to tear or fragment.
Does the Placenta Need to Be Examined Afterwards?
Yes, the delivered placenta and membranes are examined to make sure the organ is intact and no fragments remain in the uterus. This reduces the risk of infection and bleeding complications.
The provider will inspect the maternal and fetal surfaces for abnormalities, take the placenta’s measurements, and confirm the umbilical cord is attached. The attached membranes are smooth and glistening if they have been expelled completely.
The placenta is then sealed in a bag and disposed of as medical waste, unless the mother requests to take it home for cultural reasons or for encapsulation.
Recovery After Placental Delivery
After the placenta is delivered, the mother continues through the stages of labor and monitors for excess bleeding:
- Third stage: From placental delivery up to 1 hour after birth.
- Fourth stage: 1 to 24 hours after delivery.
Contractions continue during the third stage, which encourages clotting at the placental site and decreases bleeding. The mother is monitored for blood loss, cramping, dizziness, etc. Oxytocin medication may be given to promote uterine contraction.
During the fourth stage, the mother continues to be monitored for bleeding, uterine tone, and other signs of recovery. Breastfeeding can help stimulate uterine contractions to slow bleeding.
When to Call the Provider After Giving Birth
Contact your provider if you have any of the following in the hours and days after delivery:
- Very heavy bleeding that soaks more than one pad per hour
- Large blood clots larger than a golf ball
- Foul-smelling lochia (postpartum vaginal discharge)
- Severe pain or tenderness in the abdomen
- Uterus feels soft and not contracted
- Fever over 100.4°F (38°C)
- Chills, dizziness, or excessive fatigue
These may be signs you have an infection, retained placental fragments, or postpartum hemorrhage that needs prompt medical care.
Conclusion
In summary, the placenta generally detaches from the uterine wall within 5-30 minutes after birth and is expelled from the vagina shortly after. Examination of the delivered placenta is done to ensure no remnants stay behind in the uterus. Monitor bleeding and other symptoms in the hours after delivery and notify your provider if anything seems abnormal in your recovery.
