I found the management of 3rd stage my greatest challenge when I became a MIPP. The "management "of labour was always clear as a midwife I held the space as the journey evolved and the baby was born then I developed all these scenarios for 3rd stage basically wait and see unless time and bleeding interjected I was always relieved when the placenta was delivered . Now I'm an observer of the third stage and intuitvley act /not act depending on whats happening. [ie same as therest of birth. What cured my anxiety? I shared my anxiety re 3s with another MIPP J enny Parret she said you have forgotten the 3rd stage is part of the birth treat it the same as the rest and now I do. My advice , CARE FOR THE WOMAN AND SHE WILL COMPLETE HER BIRTH WHEN SHE IS READY. love Jan ----- Original Message ----- From: Johnston <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, March 21, 2002 8:29 PM Subject: RE: Finally - cord cutting and clamping
> Hi > I have been watching from some distance as this thread has been discussed, > and think your reflective response today, Maralyn, is very good. > > We need to try to understand what is actually happening, rather than > necessarily what we were taught to do. The little motto, "In normal birth > there should be a valid reason to interfere with the natural process" (WHO > Care in Normal Birth 1996) should be a guiding principle. > > I'm not sure if there is a consensus on what constitutes the gold standard > for active management of S3 (eg when the oxytocic is administered, when the > cord is clamped, if the blood is drained from the maternal end of the > severed cord &c). We had a discussion on this list some time ago about > what physiological S3 is, and it seems that there are many variations. > > Midwives attending homebirths seem to have a great variety of 'management' > practices too. (M Odent says "Don't manage third stage"). My practice is > to attempt to maintain an unstimulating and calm atmosphere in the room in > the minutes immediately after the birth, and trust mother nature (/hormones > /physiology) to get on with the marvellous job of completion. I encourage > folk to wait until S3 is completed before they make phone calls, and if > there are photos, they need to be done quietly. If a woman gave birth in > water, we usually wait 5-10 minutes as an initial rest and recovery period, > then have a warm supported chair or bed in the same room so that she can > give her full attention to the baby. I don't encourage remaining in the > water for the birthing of the placenta. Often standing up to get out of > the tub gives the woman a feeling of fullness, and she can pop her placenta > out. Staying in the same room is important to me, as I think moving to a > different space can impede progress. This all may seem pretty prescriptive > - it's not fixed in concrete, but it makes sense to me, as a mother and a > midwife. > > I think the first 30 minutes or so are crucial, and I watch the woman and > baby without engaging her in eye contact or conversation, and try to make > sure they are warm and comfortable. I don't check cord pulsation. Some > women are weary, or not able to move immediately into the completion phase. > Peaceful quiet seems to allow them to rest, until they are ready to pay a > lot of attention to baby, or want to move. Often they say "I'll stand up > now, and the placenta will come." Of course it's nice for everyone if this > happens in the first hour, but I have not had any problem with waiting > longer. Sometimes I think birth of the placenta is like a second birth - > as though there needs to be a series of contractions, dilation of the > cervix, and an expulsive effort. > > I used to worry about physiological S3 when I needed to collect cord blood > from the babies of Rh negative mothers. But I have found that a very small > amount of cord blood taken from the vessels on the fetal side of the > placenta is adequate. > > Women usually report less blood loss in the hours after the birth when they > have birthed their placentas naturally. I expect to see between 100-400ml > blood loss with the placenta. > > 'twill have to do for now. Happy birthings. Joy Johnston > > -----Original Message----- > From: [EMAIL PROTECTED] [SMTP:[EMAIL PROTECTED]] > Sent: Thursday, March 21, 2002 6:51 AM > To: [EMAIL PROTECTED]; [EMAIL PROTECTED] > Subject: Re: RE: Finally > > Thank you all for your responses to my question. I too like to leave the > maternal end of the cord unclamped, although as a student I had some > midwives > ask me to reclamp it as they wanted to know where the blood being lost was > coming from. On thinking about the responses I would like to venture that > the concern about the baby getting extra blood has been also raised in > discussions of physiologic third stage and I think Lois's response is right > on the money: it depends on the position of the baby in relation to the mum > how much extra blood the baby is getting. Regarding the stronger > contractions > causing more blood being pumped to the baby, I don't think it works this > way > for these reasons: 1. The baby's heart is pumping the blood, not the > uterus. > 2. When you augment or induce a woman in labour and if her uterus > experiences > hyperstimulation, then the baby may receive less blood not more resulting > in > fetal distress. 3. The intent of the oxytocic in third stage is to schear > the > placenta off the uterine wall with the increased contractions constricting > the uterine capillaries, if anything perhaps the stronger uterine > contractions would restrict the amount of residual placental blood > available > to the baby. 4. My original concern about the oxytocic crossing the > placenta > to the baby also seems to be mute if what I just wrote is in someway > correct. > Bottom line is I still feel like I am guessing about this. > > The question came up when as a student the mum I was caring for had agreed > to > having third stage actively managed (she had had a "long labour": tired > uterus), but she didn't realise that this meant the cord would be cut > immediately after the oxytocic was given (this was our fault as we hadn't > covered this with her in the discussion, which brings to mind the flaws of > giving informed consent in labour). So, when I was about to clamp the cord > she said "Oh, but it hasn't finished pulsing", I said "your right then, > we'll > just wait for a minute or 2" and the midwife who was supervising me said > "Oh! > but we've given the pitocin, so we have to cut the cord now". And we did, > the > mum seemed to be ok with it, she had had a lovely and triumphant birth (I > think and hope) apart from that. It was just after reading AndreaQ's lovely > story, I felt a pang of guilt and also a lack of knowledge re the > consequences of delayed cord clamping after an oxytocic has been > administered. > Again, thank you to all who responded, I am still pondering. marilyn > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. 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