THE THIRD STAGE OF LABOUR
The third stage of labour is the time between the birth of your baby and the body’s removal of the placenta or afterbirth (whenua). After your baby is born the body takes a short rest, after which you will feel more contractions or tightenings. Your womb is now shrinking and as it does so; your placenta will peel away from the womb. Since the womb muscles are in a criss-cross pattern, as it shrinks it seals the blood vessels leading from you to the placenta.
There are 2 options available to you on how this 3rd stage is managed:
*ACTIVE MANAGEMENT *PHYSIOLOGICAL/NATURAL MANAGEMENT
Choosing between Active and Physiological Delivery of the Placenta
When you plan your birth with your midwife, you can choose to have drugs to help you deliver the placenta, or to go for a 'natural' third stage.
Active Management - drugs for third stage
'Active management', or a 'managed third stage', means that you have an injection as the baby is born, or shortly afterwards, which makes your uterus contract strongly to push out the placenta quickly, and then makes it clamp down tight to reduce bleeding after the placenta is delivered. The drug most often used is Syntocinon (this is a synthetic form of your own natural hormone Oxytocin) to bring on strong contractions. The midwife then uses traction to draw the placenta out. The advantages of an actively managed third stage are that the third stage is usually over quickly, and average blood loss is lower. The mother does not usually have to 'do' anything - she just waits, while the drugs and the midwives do the work!
The disadvantages of an actively managed third stage are that some mothers feel sick or faint or have a headache after the drug is injected. There is thought to be a higher risk of trapped placenta, where the placenta is stuck inside the uterus. If a trapped placenta occurs, it usually has to be manually removed in an operating theatre.
Active management of the third stage has some disadvantages for the baby. The cord has to be clamped before the injection is given, as otherwise the baby could receive a powerful shunt of blood from the induced contractions. This could cause an 'over transfusion' - the baby getting too much blood, which could lead to jaundice. The downside of early cord clamping is that the baby does not get the benefit of the oxygen-rich blood in the cord and placenta which would come to it in a natural third stage.
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Physiological or 'natural' third stage
'Physiological management', or a 'natural' third stage, means that drugs are not automatically administered to deliver the placenta, but that the woman waits for it to arrive naturally. While she is waiting, her midwife will observe her carefully and, if she needs it, she could be given advice on techniques to help her push the placenta out. For instance, some women find that if they push as if they were trying to do open their bowels, the placenta rapidly appears. Some midwives recommend that women blow into a bottle to help push the placenta out. If, at any stage, the woman's blood loss worries her, she still has the option of having drugs to push out the placenta and control bleeding.
The downside of a 'natural' third stage is that it takes longer to deliver the placenta on average, and that average blood loss is slightly higher. It is quite normal for a natural third stage to take half an hour or an hour or more, although ten minutes is also perfectly common. The mother has to be actively involved in the birth of her placenta; she must push it out herself, and sometimes this involves moving around, and trying different positions and techniques. Your baby can be close to you while you are doing this, of course, and for many women a physiological third stage means no more than sitting down, and cuddling the baby for ten minutes or so until she feels the urge to push the placenta out.
If you do not have drugs to aid delivery of the placenta, you can choose to either have the cord cut when it has stopped pulsating, or to wait until the placenta is delivered. This last choice is a great excuse to keep your baby 'velcroed' to you straight after birth, rather than having him whisked off to be weighed and measured while you get on with delivering the placenta. On the other hand, some women feel they can't concentrate on delivering the placenta while still attached to their baby. There is some speculation that leaving the cord uncut until the placenta is delivered might somehow help speed up the delivery of the placenta, but there is no strong evidence to support this.
If the baby needs some form of resuscitation, this can be administered while the baby is still attached to the cord - giving it the benefit of all the oxygenated blood in the placenta, as some still pulses down the cord for a few minutes after birth - if the midwife has her equipment near the mother, or if the mother can move to the resus' area. If the mother cannot move to the resus area then the midwife can quickly clamp and cut the cord, just as she would in a managed third stage.
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