I should add that a physiological third stage is the natural progression
from a normal labour.
However if the woman has had a labour influenced by IOL, augmentation and
directed pushing in second stage then she is more at risk of a PPH because
her uterus has been unnaturally pushed to labour harder. In this instance
active management of third stage may be more appropriate. You need to
consider the overall situation, not merely the issue of "when do we clamp
the cord?".
Leanne.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
From: "leanne wynne" <[EMAIL PROTECTED]>
Reply-To: ozmidwifery@acegraphics.com.au
To: ozmidwifery@acegraphics.com.au
Subject: RE: [ozmidwifery] Delaying synto with active 3rd stage
Date: Tue, 14 Nov 2006 11:27:11 +1100
Sue,
You really need to decide whether your patient wishes for an active or a
physiological third stage. It can be dangerous to try and do a "half-half"
sort of third stage.
If you plan a physiological third stage then you need to:
1. Dont clamp or cut the cord until it stops pulsating.
2. Put the baby to the breast as soon as possible, this will stimulate
oxytocin release which works better than 10units Syntocinon ever does!
3. Allow the placenta time to separate without pulling on the cord.
4. If the woman is upright gravity will help, sitting on the toilet usually
works well.
5. Wait until the woman feels some afterbirth pains, then suggest she gives
a little "push"
6. Always observe for excessive bleeding but dont confuse that initial gush
which indicates the placenta is separating with excesive blood loss.
7. Be patient, have faith in the normal process!
All the best,
Leanne.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
From: Sue Cookson <[EMAIL PROTECTED]>
Reply-To: ozmidwifery@acegraphics.com.au
To: ozmidwifery@acegraphics.com.au
Subject: [ozmidwifery] Delaying synto with active 3rd stage
Date: Tue, 14 Nov 2006 11:00:25 +1100
Hi,
I'm interested if there is any research on delaying synto for say up to 5
minutes in 'active 3rd stage'.
Have been doing actively managed third stage throughout my clinical
placements as a student (nearly finished!!) with some practitioners
cutting the cord immediately, and most at about 10 - 20 seconds.
I've just prepared a powerpoint presentation on delayed cord clamping but
know I will get into a discussion around the seeming conflict between
active 3rd stage and delaying the clamping. Obviously if you don't want
the effects of synto's action - strong uterine contraction with excess
blood being pumped into bub, then you need to delay the entire process of
actively managed 3rd stage until the cord is clamped.
Does anyone practice delaying the synto injection for those first few
minutes? Any evidence of harm in doing this?
Thanks,
Sue
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