I wonder why? As soon as that baby is born, I could care less what else was happening!

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Sasha, Doula, Mama, Wife, Student Midwife

Three little wild boys and one soldier husband

Ive had quite a few physiological 3rd stages and sometimes the mums are so tired its a real struggle for them to go that extra mile, but I agree with Odent you do see a special bond forming with mum and baby at this time.

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StudentMidwife.NET Founder

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In Holland we do both passive and active. Passive management of the third stage in this country is guiding the cord and support the muscles of the stomach while 'mom' pushes it out. I saw someone naming that CCT in this topic, but for us CCT is pulling the placenta out by the cord and pushing the fundus down. Active management is giving 5 or 10 IE syntocinon im, sometimes in combination with CCT. In hospitals active management is protocol, at home we do 'what we want'. Indications for active management are long labours, blood loss, Shoulder Dystocia, or if the placenta doesnt want to come naturally. In other words: the woman does not get the choice, if neccesary she gets the medicine.
I read you give syntometrine? I don't know if that's the same as syntocinon. We have syntocinon and ergometrine (only if the placenta is already born, against severe blood loss).

Syntometrine is a mixture of syntocinon and ergometrine. (can't remember the amounts, but more syntocinon than ergometrine)

How interesting the differences in practice?

Our active mangement employs the guarding of the uterus, CCT and syntometrine given IM on or after delivery of the anterior shoulder. Many midwives deliver the baby, give the synto and then clamp and cut the cord.

We use active mangement routinely in my trust. Those women requesting physiologicals are often (read always with my mentor) are dissuaded from having physiological third stages.

Fascinating subject, and one wanting far more research IMO, I am going to read up on this alot more as it is one of our trust policies and I am interested as to the research it is based on.

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Thanks for your answer. And yes, i find it very interesting too We only give syntocinon for the placenta after the baby is born, never while. So: baby born, cord clamped and then synto. Doesn't matter though if you clamp or not, come to think of it. It's a closed circuit between baby and placenta. Ah well, everything has its reasons

Thought Id ressurect this one as its a really interesting discussion...

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StudentMidwife.NET Founder

"You're braver than you believe. Stronger than you seem. And smarter than you think."
Christopher Robin in Pooh's Grand Adventure

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I have now seen two physiological third stages, and I have to say I really do prefer them to CCT.

They seem to promote a much clamer atmosphere in the room, and it does give both Mum & baby some special time together.

I do wonder though why it isn't more of an option for women, it always seems to me that CCT is the only choice given to women, unless of course they actually say otherwise?

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Midwifemissy x

Student Midwife 2007
Student uni rep
Educational Resources Manager

PAB Support Worker

I noticed from a link on here recently the WHO recommending 'Active management of the third stage should be practiced on all women in labour since it reduces the incidence of PPH due to uterine atony ' :.http://www.who.int/reproductive-heal...r_S25_S34.html

I must admit I was very suprised by this, is this followed in general by the trusts?

I never even considered having a managed 3rd stage in my labour and didn't realise it was so unusual to have physiological 3rd stage until afterwards.

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Applying for September 2009 intake at West of Scotland Uni

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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I have never seen a physiological third stage- a few of my cohort have and we all gather round like it's some sacred story! It's so sad- and CCT just feels so unnatural- you're there pulling and staring and prodding- as if you haven't done enough to them in labour!

The really sad thing is women are definately not given informed choice most of the time, in my experience. All to often they just get "are you ok to have the injection to help your placenta come away?" making it sound as if they need it and then 'syntometrine administered with consent' written in the notes , and i have not as of yet had the courage to go over my mentor, in front of her, and explain about the difference between physiological and active. It's infuriating that its so difficult to do this.

I know that i would go for physiological 3rd stage if i was to have a baby, unless indicate ofcourse!

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"It's not the destination, it's the glory of the ride"