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Does All The Placenta Come Out During Childbirth?

I vaguely remember delivering my placentas. I know they came out because my husband was kind enough to photograph each of them as an addition to our children's baby books. I have slight memories of cramping and the doctor massaging my stomach, but I don't remember physically pushing them out. In fact, I never even thought about delivering the placenta because I figured it would slip right out along with the baby. It didn't occur to me to wonder "does all the placenta come out during childbirth?" or "will delivering the placenta hurt?"

According to What To Expect, the last stage of childbirth, the delivery of the placenta takes anywhere from five minutes to up to 20 minutes or more. Typically you will start to feel contractions again, which helps the placenta detach from the uterine wall and move it down the birth canal where the body can expel it. Sometimes the doctor will help by massaging your stomach while gently pulling on the umbilical cord, however The New York Times reported that studies suggest pulling on the cord to remove the placenta did not significantly reduce the amount of blood lost and comes with the risk of cord tearing and uterine inversion.

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As soon as you deliver your placenta, the doctor will inspect it to make sure that it came out completely in tact. If it looks as though it is missing a piece, you may have what is known as a retained placenta. This is when the placenta, or parts of the placenta stay inside the womb for more than 30 minutes after birth according to Health Line.

OB-GYN Marra Francis, M.D told Parents that any time an instrument is put into the uterus it can create scar tissue. If a mom has had a C-section or any type of uterine surgery she is at risk for retaining placental fragments. Francis stated that if only small pieces remain, a doctor may choose to give the patient Methotrexate, a mild chemotherapy drug that can kill placenta cells. Other times, doctors can reach in and pull out the pieces by hand, which carries a risk of infection. As a last resort, your doctor may need to perform emergency surgery to remove the placenta or any remaining pieces.

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A retained placenta is dangerous and can cause serious, life threatening complications. In the rare instance that placental fragments were not fully expelled, Health Line warned that you may experience a fever, a foul-smelling discharge from the vagina that contains large pieces of tissue, persistent heavy bleeding and severe pain. You may also have trouble breastfeeding because placental fragments may not allow the progesterone levels to fall as much as is necessary for prolactin, the milk-making hormone, to take effect in your body according to Belly Belly.  

As scary as this all sounds, retained placenta is rare and almost every mom is so busy enjoying her sweet newborn that she barely even notices the whole placenta delivery process.