Yes, that is recommended in our trust guidelines also, Sara Wickham (I haven't a link, but it is sure to be in one of the best practice volumes!)

wrote an interesting article on the blood loss following a physiological thrid stage to be considerably more at the time, but much less over the ensuing weeks than with active management.

I haven't seen one still, though have now seen lots of women talked out of it and been told off by a reg before for not tugging on (CCT, but it is like tug of war sometimes, I hate, hate, hate it) this placenta that simply was not coming (I had been taught not to) so occasional tugs then leaving it alone

So consequently thirty minutes later, there it was (the lady had only had syntocinon, rather than syntometrine due to high BP) and maternal effort seemed to help, she had a PPH though (ahain my fault)

So she was fine, we had a discussion about it and the midwives were on my side, What I hate most about midwifery in the hospital is the management of labour and birth, the assumption women cannot do any of it themselves

'contractions are weak' 'you're only 4 cms dilated' 'you need to push better my darling'

I hate it and active management of the third stage too, it's the final insult.

I'd be really interested to hear Lotuseaters experiences of physiologicals versus active, she must've been there for millions!

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