Active Management of the Third Stage

Question 1

What is the third stage of labour?

Answer 1

The third stage of labour is from the completed birth of the baby to the delivery of the placenta. There are two options for the third stage:

• Physiological management
• Active management

Question 2

Briefly describe physiological management in the third stage of labour

Answer 2

Physiological management is where the placenta is delivered by maternal effort without medications or cord traction.

Question 3

Briefly describe medical management in the third stage of labour

Answer 3

Active management of the third stage is where the midwife or doctor assist in delivering of the placenta. It involves a dose of intramuscular oxytocin to help the uterus contract, and careful traction to the umbilical cord to guide the placenta out of the uterus and vagina. Active management shortens the third stage and reduces the risk of bleeding, but can be associated with nausea and vomiting.

Active management is routinely offered to all women to reduce the risk of postpartum haemorrhage. It is also initiated if there is:

• Haemorrhage
• More than a 60-minute delay in delivery of the placenta (prolonged third stage)

Question 4

Briefly describe the steps in the active management of the third stage

Answer 4

Active management of the third stage involves an intramuscular dose of oxytocin (10 IU) after delivery of the baby.

The cord is clamped and cut within 5 minutes of birth. There should be a delay of 1 – 3 minutes between delivery of the baby and clamping of the cord to allow blood to flow to the baby (unless the baby needs resuscitation).

The abdomen is palpated to assess for a uterine contraction before delivery of the placenta. Controlled cord traction is carefully applied during uterine contractions to help deliver the placenta, stopping if there is resistance. At the same time the other hand presses the uterus upwards (in the opposite direction) to prevent uterine prolapse. The aim is to deliver the placenta in one piece.

After delivery the uterus is massaged until it is contracted and firm. The placenta is examined to ensure it is complete and no tissue remains in the uterus.