Over 95 % of Australian women will have their 3rd stage actively managed. It is standard procedure for most women who have their babies in a delivery suite or for women who request it in a birth centre or homebirth.
An actively managed 3rd stage entails the following:
Synthetic oxytocin hormone injection
Immediate clamping of the cord after the birth
Waiting for signs of separation
Using the cord to deliver the placenta
Delivering the membranes
Synthetic oxytocin hormone injection
Once the baby's head has emerged, the shoulders rotate inside the woman's pelvis and the baby waits to be fully born with the next contraction. As the uterus contracts the caregiver places their hands on each side of your baby's head and applies some gentle pressure to guide the baby to be born. As the body emerges the anterior shoulder (or shoulder closest to the woman's pubic bone or 'symphysis pubis') can be seen as it slips out from underneath the bone, just underneath the top of the vagina, freeing it for the rest of the baby's body to be born.
When the anterior shoulder of the baby can be seen, another caregiver (not the one delivering the baby) will inject a synthetic oxytocin hormone drug (usually Syntocinon but sometimes Syntometrine), either into the woman's thigh as she pushes her baby's body out or as soon as the baby is born. Many women will be too preoccupied with giving birth to notice this injection. Others can be a little taken by surprise if not forewarned that it will be done.
The injection is timed in this way to encourage the placenta to separate as soon as possible after the baby is born, but after your caregiver is sure that the baby is definitely going to be born and there are no problems with delivering the baby's shoulders. If you are having twins, the injection is given with the anterior shoulder of the second twin, so that the twins' placentas will not separate before the second twin is born.