For years it has been accepted by many that active management of the third stage of labour is the preferred way of birthing the placenta and membranes. But in New Zealand, midwives have been questioning this, saying that physiological birth is far safer for women who have had normal labour and no risk factors.
The latest audit of New Zealand midwives that has come from the New Zealand College of Midwives (NZCOM) suggests that women who have physiological third stage of labour, overseen by midwives who know what they are doing, are less likely to bleed heavily compared to women who have active management. This result is contrary to the commonly held belief that active management of the third stage reduces blood loss following birth.
Follow-up to this audit is going to be carried out by Professor Cecily Begley (Dublin) - she is reviewer for the Cochrane Database. Professor Begley is coming to New Zealand in January 2010 to talk to midwives who regularly carry out physiological management of the third stage. If you are interested in knowing more, please contact NZCOM.
Dixon et al. (2009). Midwives care during the third stage of labour: an analysis of the New Zealand College of Midwives Midwifery database 2004-2008. New Zealand College of Midwives Journal, number 41, October, p. 20
Image: 'placenta and amniotic sac - _MG_3995' sean dreilinger