The third stage of labour is when the placenta / whenua (afterbirth) comes away from the wall of the uterus and is delivered.
There are two ways this can be managed and both of these will be discussed and you will be asked to give written consent for the one of your choice. Your choice can be changed at any time up until the placenta is delivered.
(1) By the giving of a drug called an ecbolic - (Active Management)
This is an injection given into the mother's leg just as the baby is born. This drug makes the uterus tighten (contract) and helps prevent excessive bleeding (haemorrhage) which may occur from the wall of the uterus where the placenta has been embedded.
When this injection is given, it is necessary to:
Clamp and cut baby's cord at the time of birth
Hold the uterus up by pressing on your abdomen above the pubic bone and gently pulling on the cord to help the placenta be delivered quickly.
This is because the injection hastens the closure of the cervix and the placenta needs to be delivered before this happens.
Advantages of having the injection:
There is less likely to be a haemorrhage following the birth.
Disadvantages of having the injection:
You may suffer from nausea and vomiting and some women get a headache.
(2) By waiting for the placenta to deliver naturally (Physiological Management)
The cord is left unclamped and uncut at least until it stops pulsating, or more often until after the placenta is delivered.
The baby is held skin to skin with Mum. This allows time for you to meet the baby without interference from attendants. In time the mother feels some contractions and pushes the placenta from her vagina.
The advantages of physiological management:
No injection and therefore no side effects of nausea, vomiting or headache
The baby continues to receive oxygenated blood via the placenta while it begins to breathe and it receives blood to fill the increased vascular space in the blood vessels of the lungs which occurs when the lungs inflate with the first breath.
The disadvantages of physiological management:
Haemorrhaging is more frequent (if haemorrhaging an ecbolic injection is given).
The third stage of labour is longer.
Mothers are more likely to have a haemorrhage if they have:
Twins, triplets etc
A big haemorrhage with a previous pregnancy
A drip to make labour stronger
An abnormal birth i.e. Forceps, ventouse or caesarean (c-section) birth
The placenta gets stuck on the wall of the uterus
A very fast, or a very long labour
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