Physiological vs Managed Third Stage

[Mummato2]

I'm hoping that Alan might be able to jump in on this.

I had my midwife appt this week, and she asked if I wanted a physiological or managed third stage. Now we are storing cord blood - so it doesn't really apply to me BUT I had a conversation with my mother about both choices (she's a MW) after having the same conversation with my MW and I was very disappointed to hear of my mum's lack of knowledge AND her giving out incorrect advice to her patients.

She claims that a physiological third stage causes more manual removal of placenta and PPH

Now I happen to agree in part that a physiological third stage leaves the 30% that Synto would have stopped hemorrhaging open to the PPH HOWEVER I can't believe that a physiological third stage would cause more manual removals??????? Wouldn't this be because the Synto was too efficient and didn't allow the placenta to pass before closing the cervix?

I'm confused and would like clarification hopefully in the way of a study I can point her to.

To be adamant you know best is great - but I wish she'd get her facts because many women are delivered by my mother on a weekly basis and I'd hate to think of the experience they're getting at the hands of her out of date, old school information

[alioops]

I had a physiological 3rd stage with DD3 and it was faster and more thorough than my other babies. the placenta was complete and my ob was surprised as was the mw, but they were rude L&D ones with no faith in our bodies.

[BellyBelly]

I'm sure there are a fair few threads in this section, quite long ones too... have a search through this forum and you will find plenty.

[BellyBelly]

Heres a huge stickied thread in this forum

https://www.bellybelly.com.au/forums...ird-stage.html

[Mummato2]

Thanks guys - I was more looking towards a study perhaps comparing women who have had both and the stats for each?

I'll check out those links though - thanks Kelly!

[jackrose]

I commend you Mummato2 for trying to chase up the facts, you have certainly not taken after your mother have you?

I don't have any research to help you out, but I did read (somewhere) that there may be more to the active vs physiological management debate than appears on the surface. (I apologise for my vague reference to where I read this but I have read so much literature in the past months prepping for this birth!)

My understanding is that one of the complications with the birth of the placenta is that in modern obstetrics we practice routine early cord clamping. The early cord clamping means that the blood that was designed to move into the babies body is stopped and therefore the placenta has more blood in it than preferable. This then means that the uterus has a harder time contracting to expel the bigger placenta and is more likely to lead to PPH. I believe a study showed that when delayed cord clamping was used there was less PPH in general. I know this is not relevant to your situation as you are wanting to bank the cord blood, but it does muddy the waters when you are trying to compare a natural method of placenta delivery (one that has already been rendered unnatural by early cord clamping) with a managed delivery. It would be better to compare the three - managed vs physiological w early cord clamping vs physiological w late cord clamping.

Hope that made sense!

Otherwise I did find this which may head in the direction you are wanting

The research evidence

There is limited evidence from studies comparing having a natural third stage with having active management, largely because there are several different inter-dependent components of these practices, and different women have different levels of risk. There are several trials currently in progress to try to produce more evidence about how third stage of labour should be managed.

A review of several studies suggests that active management of third stage reduces blood loss and the likelihood of having a PPH (blood loss over 500mls) or severe PPH (blood loss over 1000mls). It can also reduce anaemia after the birth and the need for a blood transfusion. [See the Cochrane Review on third stage.]

However, some of the studies included in this review may have limitations.

Some included women who were at high risk of PPH or who had complications during their labour which could have contributed to an increased risk of PPH.
In some of the trials, the method of active management of third stage varied, and some of the women receiving a physiological third stage may have had some elements managed (e.g. early cord clamping or controlled cord traction) which may have contributed to blood loss.
In most of the trials, the usual practice was an active third stage and some of the midwives were unfamiliar or not confident with the practice of allowing a physiological third stage