The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Article on Third Stage by Victoria, Australia Midwives

Discussion on physiological management of Third stage (of labour) by independent midwives in Victoria, Australia

The Cochrane Library has a review of trials comparing: Active vs expectant management of the third stage of labour (1996) Although the conclusions were that routine 'active management' resulted in less blood loss, the reviewer stated the "The implications are less clear for other settings including domiciliary practice ... and maternity units in which expectant management is the usual practice". It was noted that the midwives involved in the trials included in this research may have been more familiar with active management (prophylactic oxytocin after the birth, early clamping and cutting of the cord, and controlled cord traction). The only details of expectant management given in the review are waiting for signs of separation and allowing the spontaneous expulsion of the placenta aided by gravity (+- nipple stimulation).

The basic reasoning behind the physiological management that is practiced in homebirths I have been involved in seems to be NOT clamping and cutting the cord until all pulsation has ceased, and often not until after the placenta has been born. The retro-placental clot that is formed in this pattern of management is obviously very different from the bleeding that occurs with early clamping, while the placenta is still functioning. My conclusion, in the light of this evidence, is that although active management has been recommended as the preferred option in hospitals, there is no evidence to discourage the continuation of physiological management in homebirth practice.

Reasonable midwifery practice includes having oxytocics for use when indicated. There are unpleasant side-effects (including nausea, vomiting, and increased levels of pain) in active management. Advantages of physiological management include early establishment of nurture/bonding/breastfeeding which may be compromised if the mother is having to deal with nausea &c.

Joy Johnston FACM IBCLC

Joy Johnston, midwife
Melbourne, Australia
joy@aitex.com.au

The Online Birth Center News is copyright 1997 by Donna Zelzer. The individual writers hold copyright to the individual messages. Copies may be freely distributed electronically, as long as

1. This permission and the authorship of the articles are retained in any additional publication of the article.
2. The content of the article is not changed in any way.
3. You do not charge for the article, other than the cost of download and/or connect time, or photocopying costs, in the case of a printed version.