What it is
Historically part of the active-management package, controlled cord traction (CCT) is now considered optional by WHO when a skilled birth attendant is present. It should never be done before the placenta separates or without countertraction on the uterus (to prevent inversion) or with a slack cord (to prevent avulsion).
Evidence review links
Each link opens the full review on the publisher's site in a new tab.
Possible benefits
- May slightly shorten third stage and reduce retained placenta when done properlyReview sources ↓
Possible risks
- Uterine inversion if done before separation or without countertraction (rare but life-threatening)Review sources ↓
- Cord avulsion (cord tears from placenta)Review sources ↓
Alternatives
- Maternal effort (push while sitting on a bedpan or squatting)Review sources ↓
- Watchful waiting for spontaneous deliveryReview sources ↓
Current evidence
WHO 2018 recommends CCT as optional (rather than routine) when a skilled attendant is present. Cochrane review found CCT reduces average blood loss slightly with no effect on severe PPH.
Where the evidence is clear · where people may choose differently
For most topics, guidelines from ACOG, WHO, and other major bodies broadly agree on the core safety points (when to act in an emergency, informed-consent standards, monitoring baselines). Where reasonable people — and even guidelines — differ tends to be around thresholds (when to start or stop something), preferences (comfort, environment, support), and values (how you weigh small risks against benefits). Use the questions below to explore those pieces with your care team.
Educational only. Your care team can help you weigh what applies to your specific situation.
Related evidence topics
- Active Management of the Third StageA three-part package: prophylactic uterotonic (usually oxytocin), controlled cord traction, and uterine massage to reduce postpartum hemorrhage.
- Physiologic (Expectant) Third StageLetting the placenta deliver on its own without routine uterotonics or cord traction, with careful observation.
- Delivering the PlacentaThe placenta usually comes out on its own within 5–30 minutes after the baby, with a small gush of blood and a mild contraction. What signs mean it's ready, what your team is watching for, and what to expect physically.
- Retained PlacentaThe placenta hasn't delivered within about 30–60 minutes of the baby. Options include waiting, uterotonic dose, and manual removal.
Questions to ask your care team
- ?Is cord traction routine here or done only if needed?
- ?What happens if the placenta doesn't deliver in 30–60 minutes?
Universal questions (works for any decision)
A short BRAIN-style set you can bring to any conversation about interventions, monitoring, or care decisions.
- ?Why are you recommending this now — is it urgent, routine, or optional?
- ?What happens if we wait an hour (or longer) before deciding?
- ?What signs would tell us this is working — or that we need to change course?
- ?What are the alternatives, including doing nothing?
- ?What would you recommend if this were your family?
- ?What would change your recommendation?
Sources & provenance
Tap a source to open the original guideline or review in a new tab.
- WHO recommendations on prevention and treatment of postpartum haemorrhage — WHO
- Cochrane: Controlled cord traction for the third stage of labour — Cochrane
Plain-language paraphrase. Re-verify before publish.
Last reviewed: 2026-07-03
Further reading — canonical references
Read the source material directly. Each link opens the publisher's own current guidance in a new tab — cross-check what we summarize against what they say.
Tier 1 · Clinical guidelines
Tier 2 · Systematic reviews
Educational only. Guidelines evolve — the linked publisher pages will reflect newer guidance than any static snapshot.
Version history — v1.0.0
v1.0.0 · 2026-07-03 · LlaMamma editors
Initial cord traction topic.
New guidance from ACOG, WHO, Evidence Based Birth, or other listed sources is recorded here and can be updated remotely without a new app release.