Looking over a few of the discussions on here, there has already been some debate relating to the third stage of labour... There has been mention of leaving the cord pulsating and when/if to administer syntometrine. I have to admit a serious lack of knowledge about leaving the cord pulsating, so if anyone has anything to contribute on this topic I would be very interested. Are there any particular articles or guidelines anyone can recommend? I have to say that I'm not overly impressed with the new NICE guidelines in relation to the third stage, anyone else agree?

Let the debate commence!

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3rd year Student Midwife

Hey there, I'm all for leaving the cord pulsating, here are a couple of articles as a taster, Mercer has written oodles on the topic, and I've just read the guidelines today and they are a little mm wishy washy certainly don't mention when to clamp cord, just says early doesn't it? But I do like the fact that for physiological they give up to an hour before intervention, thats surely a step in the right direction x

http://www.ncbi.nlm.nih.gov/sites/en...&dopt=Citation

http://www.ncbi.nlm.nih.gov/sites/en...&dopt=Citation

very interested in what everyone thinks of this...I asked that they not clamp the cord until it stopped pulsing so that the baby could get all the beneficial blood, but I didn't realize until after he was born that pulling on the cord to help deliver the placenta was a baaaaaad idea. Again, I don't have any preceptor, so I'm not training and all dr's in the hospital and even my midwife pulled on the cord, so I don't have anyone to discuss this with. They do it just because...

If you have had an oxytocic drug (used for third stage) usually given in the leg then yes they do "pull on the cord" its called CCT or Controlled Cord Traction, this is done after signs of seperation are sign ie. a gush of blood, you also palpate the abdomen to ensure she is contracting otherwise you should leave alone.
However if you had a physiological 3rd stage (no injection) then NO they should not have pulled on the cord, they should let it be, put the baby to the breast and watchful waiting until you probably feel the urge to birth it yourself then they just catch it in the lovely kidney dish lol

I have never seen a hospital birth where they did not give pitocin for the third stage, usually IV since it's almost always that an IV is done when you're admitted in labor, unless you throw a big fit.

OMG the practice seems so bizarre to me you should do an elective with an indy mw to see a different side completely, we only give IV if the woman is haemmorhaging, or if she is having labour augmented for some risk factor.
So to your original post they were right it seems to practice CCT, the old pulling on the cord, however only if its ready-any resistance and you should stop. I am always worried of pulling the cord too much, one of the mw's I worked with said "come here" tutted and said "I'll do it" and the cord snapped (inside I laughed) outwardly I looked shocked and she then added all embarrased "thats never happened to me before" hhmmm me thinks differently x

This is America we're talking about...there's such a huge difference between hosp and homebirth. Traditional mw's (can only do homebirths) only give pitocin in case of hemorrhage and usually encourage nursing, nipple stim, herbs to help the uterus contract and the placenta to deliver.

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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yes this is a really interesting debate, thus the reason I'm doing it for dissertation 1 chapter on Active v physiological and chap2 on timing of cutting and clamping (oops other way round lol) and chap 3 on which drug to use.
The grande multip bit always gets me it doesn't seem like the evidence is substantial does it?

Absolutely agree about substantial evidence Tracy, would love to read all your hard work once completed. Mabe we could change somethings in the NZ system

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