The Physiological Management of Third Stage Labor

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Discuss the physiological management of third stage labour

A woman’s third stage of labour is an extremely precious and important milestone, as it marks her transition into motherhood (Fry, 2007). The significance of this stage has been recognised since the time of the ancient Greeks where Aristoteles (384-322 BC) suggested the use of weights around the umbilical cord or causing a woman to sneeze to assist the delivery of the placenta (Gulmezoglu & Souza, 2009). However, over the last decade or more there has been great debate over the best and safest management of a woman’s third stage of labour (Stables & Rankin, 2011). This essay will look at the elements that make up physiological or expectant management of a woman’s third stage of labour as well as discuss associated issues. Johnson and Taylor (2011) describe the third stage of labour as the period from when the baby is delivered to when the placenta and membranes are expelled from the mother. Harris (2011) expands upon this definition by outlining three separate phases – latent, contraction/detachment and expulsion. The latent stage is characterised by the period between the delivery of the baby and when the placenta begins to separate from the mother’s uterus. In the contraction or detachment phase, the myometrium under the lowest part of the placenta contracts and a “shearing” occurs which causes the placenta to tear away from the decidua. Finally, in the expulsion phase as the uterus contracts, the membranes also detach and along with the placenta, moves into the vagina to be delivered (Johnson & Taylor, 2011). German gynecologist Johann Friedrich Ahlfeld (1843-1929) was the first to propose a “hands off” approach to third stage labour, which subsequently contributed to the expectant or physiological management methods used today (Gulmezoglu & Souza, 2009). Fry (2007) states that it permits the woman to deliver the placenta and membranes on her own accord in a spontaneous manner leaving the umbilical cord in tact until pulsation is no longer felt. This process may last between 5 to 30 minutes, but may take as long as an hour (Stables & Rankin, 2011; Hastie & Fahy, 2009). To support the woman in a natural third stage labour, Hastie and Fahy (2009) suggest the use of a ‘Midwifery Guardianship’ model that includes elements such as skin-to-skin contact between mother and baby as soon as possible after the birth, a safe and encouraging environment, mother and baby kept warm, no cord traction or fundal interference, self-attachment breastfeeding and sitting in an upright position to allow gravity to assist in delivery of the placenta. As previously outlined, an important issue impacting upon the successful implementation of this stage is the physiology of the woman and her environment, and is referred to by Fahy et al. (2010) as “holistic psychophysiological care”. This places an emphasis on the right conditions for the optimal functioning of a woman’s physiology, including feeling safe, warm and secure. If this fragile balance is interrupted, an increase in postpartum haemorrhage (PPH) or other complications may occur (Buckley, 2004). If a woman is feeling stressed or fearful in third stage labour, this may activate the sympathetic nervous system, triggering the release of catecholamines which in turn inhibits the release of oxytocin – an important hormone that contracts the uterus and assists in the progress of the third stage of labour (Gyte as cited in Hastie & Fahy, 2009). On the other hand, if a woman feels warm, calm and safe, the woman’s parasympathetic nervous system is in control and allows for the release of oxytocin upon the smell, touch and feel of her baby and ultimately that strong uterine contraction needed to facilitate a physiological third stage of labour and a state of haemostasis (Hastie & Fahy, 2009). However, according to Walsh (as cited in Fry, 2007) support of physiological third stage is becoming less common....
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