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Third Stage

Have you considered your preferences for the third stage of labour? 

Did you know that you have options? 

The third stage of labour is after baby is born and your body expels the placenta.  

Active management is routine in most hospital settings, where the risk of postpartum hemorrhage is higher. It involves giving a prophylactic uterotonic (artifical oxytocin), early cord clamping and controlled cord traction to deliver the placenta. 

Research suggests it is uncertain whether active management reduces the number of babies with jaundice requiring treatment. Research also suggests that it may increase maternal diastolic blood pressure, vomiting after birth, afterpains, use of analgesia from birth up to discharge from the labour ward, and more women returning to hospital with bleeding.

It’s important to note that the research was done in HOSPITAL settings (not home birth)

Research has found that active management:

  • Reduces mean maternal blood loss at birth and ‘probably’ reduces the rate of primary blood loss greater than 500 mL

  • Probably reduces the mean birthweight of the baby, reflecting the lower blood volume from interference with placental transfusion

  • May reduce the need for maternal blood transfusion. 

The research concluded that;

“Although the data appeared to show that active management reduced the risk of severe primary PPH greater than 1000 mL at the time of birth, we are uncertain of this finding because of the very low‐quality evidence. Active management may reduce the incidence of maternal anemia following birth, but harms such as postnatal hypertension, pain and return to hospital due to bleeding were identified.
In women at low risk of excessive bleeding, it is uncertain whether there was a difference between active and expectant management for severe postpartum hemorrhage.” 

Researchers went on to say:

“Women could be given information on the benefits and harms of both methods to support informed choice. Given the concerns about early cord clamping and the potential adverse effects of some uterotonics, it is critical now to look at the individual components of third‐stage management.” 

So what is the alternative to active management in the third stage?

  1. Expectant management

  2. Mixed management

Expectant management is a 'hands-off' approach which involves looking for signs of placental separation and spontaneously delivering the placenta.

Mixed management is utilizing components of active and expectant management, without remaining exclusive to all components of either.

Research has found that a safe and effective physiological placental birth requires effective endogenous oxytocin release, which is facilitated by:

  • Physiological birth

  • An environment that supports the release of natural oxytocin- Dim lights, warmth, comfort, soft voices

  • Undisturbed skin-to-skin after birth

  • A calm, undisturbed environment- No clinical observations, loud voices or busyness in the room

  • No prescribed timeframes- Allowing time and space for the physiological release and delivery of the placenta without looming timeframes

Knowing this information, what would you choose?

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