Wow it is so fascinating to see what the practice is regarding third stage around the globe. Here in NZ it is a choice we give to women after all the pros and cons have been discussed. I do agree that in the hospital system it tends to be actively managed (Sytno) and out with my indy it is expectant management.

If we are with a grand multip in hospital we set up the IV synto with fluids as they are more likely (apparenty) to have PPH. Depending on the history of the woman, I encourage to do expectant however always having synto nearby in case.

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