Retained placenta

A placenta is an organ that grows naturally during pregnancy. It acts as a bridge between mother and baby, delivering all the food and oxygen they need to grow. It also removes waste products that your baby doesn’t need.

It usually comes out with your baby during birth, as you no longer need it. However, sometimes, this doesn't happen.

If your baby is delivered by caesarean section, the placenta will be removed at the same time. If you have a vaginal birth, you’ll push it out yourself, either without medication or with the assistance of oxytocin to help your womb contract.

Sometimes, some or all of the placenta can become stuck inside your womb or cervix. This is called a retained placenta. You can’t prevent this from happening, and you’re not at fault if it does happen.

It’s really important to get help as quickly as possible. If it’s not removed, it could cause problems.

How long can you have retained placenta?

Your midwife or doctor will time how long it takes for your placenta to be birthed after the baby. They’ll diagnose you with a retained placenta if:

• You’ve been given an injection to help you birth the placenta, but it takes longer than 30 minutes.
• You haven’t been given an injection and it takes longer than one hour.

It’s dangerous to retain the placenta any longer than this. If this happens, you will need treatment to help you release it.

There’s a few things that your midwife or doctor may do to help you release the placenta, including breastfeeding your baby as soon as it is possible and getting you to change to a squatting or sitting position. ^{Footnote [1]}.

During childbirth, your womb and muscles can get very tired. This makes it hard to squeeze the placenta out, especially after a long labour. To help with this, your midwife or doctor may also try to boost your levels of oxytocin. This hormone is usually known to cause feelings of love, but, during childbirth, it also helps you to squeeze and contract your muscles to birth your baby and release your placenta. They’ll boost your levels of oxytocin by:

• Asking you to breastfeed your baby.
• Giving you an injection of oxytocin.

Sometimes, this doesn’t work, and your healthcare professional may try to remove the placenta by hand. They’ll guide you through this process.

Finally, if this doesn’t work, you’ll need to have surgery to remove it.^{Footnote [1]}

Surgery for retained placenta

If you need surgery, you’ll be taken to a doctor who specialises in childbirth (an obstetrician). If the baby doesn't need any extra help, your birth partner and baby can come with you, or they can stay elsewhere while you have this done.

You’ll be given medicine through a small tube, which will be inserted into a vein in your hand or the crease of your arm. This is to help your womb to stay contracted and to prevent heavy bleeding.

Next, your healthcare professional will check your vagina to see where the retained placenta is. This can be painful, so you’ll be offered pain relief. Remember, if you’re in pain at any time during the surgery, you can stop the obstetrician and tell them.

Before your surgery, you’ll also be offered an epidural. This is an anaesthetic that is given to you through your spine. An epidural does not make you to sleep, so you’ll be awake, but you shouldn’t be in pain.

The obstetrician will then remove the placenta using their hands. This is known as a manual removal of the placenta.

• If they found the placenta in your cervix, they’ll pull it out through the vagina.
• If they found the placenta in your womb, they’ll first detach it with their fingers and then pull it out.

Finally, you’ll be given antibiotics through your canula to prevent infection, and you’ll be prescribed antibiotic pills to take home. ^{Footnote [2]}

Retained placenta complications

Sometimes, some small pieces of placenta can still be left in the womb, even after surgery.

If you give birth and don’t have a retained placenta, you can still have cramps, bleeding, and feel uncomfortable for days or weeks afterwards. However, if you still have some retained placenta fragments, you may also have:

• Breathing difficulties.
• A high temperature.
• Vomiting or feeling sick.
• Very bad pain in your pelvis.
• Heavy bleeding and blood clots from your vagina (if you’re worried about this, wear a sanitary towel and show it to your midwife or doctor. Do not use a tampon, as it could cause an infection).

If you have any of these retained placenta symptoms or any other symptoms that worry you, you should talk to your midwife, doctor or health visitor as soon as possible.^{Footnote [3]}

There’s a few reasons that the placenta may not release:

• It’s attached too deeply into the womb (this is known as placenta accreta ^{Footnote [4]}).
• The umbilical cord detaches from the placenta during birth.
• The womb did not contract enough to detach the placenta.^{Footnote [2]}

What increases the risk of retained placenta?

While there are some things that can make a retained placenta more likely, they aren’t things that you can change. There’s nothing you can do that will increase or decrease the chance of a retained placenta.

The chance of a retained placenta increases if you:

• Have had a retained placenta before.
• Have given birth before.
• Are aged 35 or older.
• Had your labour induced.
• Have given birth prematurely.
• Have had placenta previa, which is an abnormally invasive placenta.
• Have had uterine anomalies or uterine procedures ^{Footnote [5]}

If a retained placenta is not treated, you may start to bleed heavily. This is known as a Primary Postpartum Haemorrhage (PPH), and it can be very dangerous.

Remember that your healthcare team will be at the birth to help you, and they’ve treated retained placenta many times before. In the unlikely event you do have a retained placenta, they’ll be able to help you, whether you’re in hospital, giving birth at home, or anywhere else.

Having a retained placenta in a previous childbirth does increase the likelihood of it happening again, and there's no specific way to lower this risk. However, it’s important to remember that each pregnancy and childbirth is unique. Just because it has happened before doesn’t mean that it will happen again.

During childbirth, you’ll be helped by highly trained and skilled medical professionals. They'll be well prepared to help you if you do have a retained placenta. 

It’s normal to have worries about your pregnancy and childbirth. Don’t hesitate to speak to your midwife about them; they’re there to support you.

You could claim for treatment for a retained placenta using your health insurance cover. The first step is to get a referral from your GP, or through our Aviva Digital GP app^. Then you can make a claim through MyAviva, over the phone, or online.

If we confirm your claim meets the terms of your policy, we’ll pay for the treatment directly. Just be sure to tell us if you need more tests or treatment, or if your hospital or specialist changes.

It’s good to have one less thing to worry about. It takes Aviva.

^ This service is a non-contractual benefit and can be withdrawn or amended by Aviva at any time