I can empathise. I am on the rough road of asking for a Phys third stage. I have had a previous PPH - but there were circumstances that raised my risk factor (long labour that was intefered with on a regular basis!!). I still have a raised risk factor with the history of PPH and Grand Multiparity, but I do feel that my body will be better off for the hands off labour that I am aiming for.

I am agreeing to the canula though as it can be harder to put in when things have already gone wrong. It is evil to get it put in and you need to make sure they don't stick it near the wrist because that is the absolute worst place to have it, and ask for the small one because you don't even notice it. But you can refuse it, yes. They will probably feel better with the canula though and I find a little bit of give helps them give a bit back without getting uptight and treating me like a difficult patient.

Also, early clamping can cause a litany of issues - including blood clotting around the placenta which can lead to PPH! Cord Traction too can cause a whole bunch of issues like incomplete placenta and introverted uterus. Yes, I just spent weeks reading all this to make sure I was making the best decision despite my risk factor. I feel that asking for the third stage to be hands off is giving my body the best chance to NOT pph, rather than trying to prevent it from happening when you have done everything possible to practically ask for it. I'd definitely recommend doing all the reading I have, because it is really does make it best for you to decide if you want to go the distance with an unwilling hospital.