The amniotic sac is delivered along with the placenta during the third stage of labor, which begins immediately after the baby is born and typically lasts about 7 to 10 minutes. The sac, placenta, and umbilical cord come out together as a unit commonly called the “afterbirth.” From there, the afterbirth is inspected by your care team, and in most cases, disposed of as medical waste.
How the Sac Leaves Your Body
The amniotic sac is made of two thin membrane layers: the amnion (the inner layer that touched the fluid surrounding your baby) and the chorion (the outer layer that was attached to your uterine wall). During pregnancy, these membranes are continuous with the placenta, forming a single connected structure. When it’s time for delivery, the sac usually ruptures on its own or is manually broken by a provider, releasing the amniotic fluid in what’s commonly called your “water breaking.”
After the baby is born, your uterus continues to contract. These contractions serve two purposes: they reduce blood flow to the site where the placenta was anchored, limiting bleeding, and they help separate the placenta and its attached membranes from the uterine wall. Once separation occurs, your provider may guide the afterbirth out using gentle traction on the umbilical cord combined with pressure on your abdomen. The entire process takes about 7 to 10 minutes on average, though it can be shorter or longer depending on how the third stage is managed.
Why Your Care Team Inspects It
Once the afterbirth is delivered, your midwife or doctor examines it carefully. They lift the cord, hold the placenta up, and spread the membranes out to check for completeness. A key thing they’re looking for is a single hole in the membranes, which is the opening the baby passed through. They also separate the amnion from the chorion by peeling the inner layer back over the base of the umbilical cord, confirming both layers are present and intact.
The reason this inspection matters is straightforward: if pieces of membrane or placental tissue remain inside the uterus, they can cause prolonged bleeding, infection, or longer-term fertility problems. Retained tissue occurs in roughly 3% of pregnancies. If your provider suspects the membranes are incomplete, they’ll let you know and may recommend monitoring for increased bleeding, passing clots, or signs of infection in the days that follow. In some cases, further intervention is needed to remove the retained fragments.
The placenta may also be swabbed for testing if there are specific concerns, such as suspected infection during labor, foul-smelling amniotic fluid, prolonged rupture of membranes (24 hours or more before delivery), or a baby born in unexpectedly poor condition.
What Happens to the Uterus Afterward
With the afterbirth delivered, your uterus begins a process called involution, essentially shrinking back to its pre-pregnancy size. Contractions continue after delivery (sometimes called “afterpains”), and these serve to close off the spiral arteries where the placenta was attached. This is your body’s primary defense against postpartum hemorrhage. Over the following days and weeks, the uterus sheds extra tissue and blood through vaginal discharge known as lochia, which gradually tapers off.
Disposal, Release, and Donation
In most hospital births, the placenta and membranes are treated as biohazardous medical waste and disposed of accordingly. However, many parents choose to take the placenta home. In Texas, for example, state law allows the mother or her spouse to request release of the placenta, which must be sealed in a container, labeled, and taken home as soon as possible. Hospitals can deny release if there’s evidence of certain maternal infections or if the placenta needs pathological examination.
The amniotic membrane also has a second life in medicine. Donated membranes are processed and used as biological grafts for wound healing, including treatment of burns, chronic ulcers, and corneal injuries. They’ve also been used in dental and neurosurgical applications, and as adhesion barriers in certain surgeries. Most of these medical products are processed to remove cells, leaving behind the collagen-rich scaffold that promotes tissue repair.
When the Sac Doesn’t Break Before Birth
In rare cases (fewer than 1 in 80,000 vaginal deliveries), a baby is born still fully enclosed in the intact amniotic sac. This is called an “en caul” birth. The sac is simply opened after delivery to allow the baby to breathe. It looks dramatic but doesn’t change the management of the birth or the third stage of labor. The membranes and placenta are still delivered and inspected the same way.
Lotus Birth and Other Practices
Some families choose a lotus birth, in which the umbilical cord is never cut and the placenta remains physically attached to the newborn until it naturally detaches. This typically takes 6 to 7 days. In documented cases, the placenta is washed, salted, and wrapped in absorbent material, sometimes with herbs like lavender to manage odor. The practice is rooted in spiritual beliefs. Some families view the placenta as a twin or companion to the baby. During a lotus birth, the third stage of labor is managed passively, without the use of medications to speed placental delivery or cord traction.