Postpartum Afterbirth & Hemorrhage: Timing & Natural Processes

Question
Hi!  I am an author under contract for the book I am presently writing.  I need to know how long (minutes?) after the birth of a baby is the afterbirth delivered.  Is that a natural process or does the nurse or doctor help?  Also, could you please tell me when a woman is most likely to hemorrage after the birth of a baby?  I really need this to occur immediately after the afterbirth is delivered.  Is that a viable scenario?

I would really appreciate any information you can give me.  

Answer
Hello Karen. Well, the placenta can come within seconds of the birth of the baby, or it can take 30-40 minutes. In a hospital delivery the dr. would rarely wait for the placenta more than 10 minutes- they are always in a hurry. Very often the dr. pulls on the cord and dislodges the placenta before it is ready and that will cause a hemorrhage. The uterus needs to contract tightly to close the blood vessels that fed the placenta. The tightening of the uterus is what pushes the placenta off the uterine wall. If the placenta is pulled out, the uterus often does not contract over those blood vessels fast enough and the excessive bleeding occurs. Midwives NEVER pull on a placenta for that exact reason. Doctors however, know that an OR is just around the corner and if they need to they can get her into surgery fairly fast. They don't take into account the mental trauma they are causing due to separation from baby and needless blood loss. Another common reason for a hemm. is a long, exhaustive labor- usually due to medical interventions like induction- and the uterus is too tired to contract over the open blood vessels. Hope that helps- feel free to post again. Cheri.