1st stage, check. 2nd stage, check. 3rd stage- don’t bother trying.

Apparently this is the message from our caregivers. Never mind that you’ve grown a human, got yourself dilated and helped it on its way out. It’s that pesky placenta you’ll never cope with.

It’s certainly true that the period between birthing the baby and completion of the 3rd stage is the most dangerous for the mother. But to what extent? And what other factors play a part? Does the increased risk warrant a “don’t even bother trying” approach?

I believe we are entitled to understand the absolute risks involved, rather than an ‘increased likelihood’ of postpartum haemorrhage (PPH) just being cited.

And I believe that we are entitled to understand the whole picture much more clearly. That it’s not a level playing field,  and that a ‘managed’ third stage isn’t the only way to decrease the instance of PPH- that the type of labour you’ve had, and your environment can impact on how the third stage unfolds.

Here are some resources to help to make informed decisions around our 3rd stage preferences, because we cannot give consent, if we are not informed.

From Midwife Thinking, a good look at the whole picture, and why different choices will make sense in different circumstances.

From NICE, what should your midwife be explaining to you about the risks and benefits of each approach? What options do you have? If you opt for natural, and things don’t progress, when might you consider switching to active management?

From Dr Sarah Buckley, a comprehensive look at many considerations.

Of course, there are circumstances in which we can be extremely grateful that a managed 3rd stage is available. Particularly when labours are regularly intervened with  in some way or another- we can’t assume to be able to walk away part way through the process without consequences.

But for many women, with low risk pregnancies and deliveries, in wonderful home environments particularly, there’s a fair chance their bodies will continue to function perfectly, undisturbed and without interference.

I’m not saying blindly opt for a natural 3rd stage. I’m saying give women the info, and let them decide.





Close Menu