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What is it
After the baby is born, the placenta is delivered with the body's natural contractions, without routine Pitocin or controlled cord traction.
How your body works here
After the baby is born, the uterus shrinks sharply, which shears the placenta off the uterine wall. Baby-led breastfeeding and skin-to-skin trigger natural oxytocin pulses that both deliver the placenta and clamp down the open blood vessels where it was attached. Active management gives synthetic oxytocin to guarantee that clamp-down and reduce hemorrhage risk; physiologic management relies on the body's own oxytocin surge.
Benefits (B)
- Less intervention if all is going well.Review sources ↓
- Supports skin-to-skin and undisturbed early bonding.Review sources ↓
Risks (R)
- Higher risk of postpartum hemorrhage compared with active management in some studies.Review sources ↓
- Requires careful monitoring and clear thresholds for switching to active management.Review sources ↓
Alternatives (A)
- Active management (routine uterotonic, controlled cord traction).Review sources ↓
- A modified approach with selective uterotonic use.Review sources ↓
Evidence summary
WHO and ACOG recommend active management to reduce hemorrhage risk in most settings. Physiologic third stage may be appropriate for select low-risk situations with experienced support.
Sources
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Questions to ask your provider
- What is the hospital's standard?
- What signs would change the plan?
Intuition & Nothing/Wait (the I and N in BRAIN)
What is your gut telling you? What happens if you do nothing or wait?
Add to my birth plan
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After you talk it through
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