Third Stage Management

three immediate physiological benefits of skin-to-skin contact for a newborn

Stabilisation of heart rate, breathing, and temperature (NEWS).

maternal benefit of skin to skin

It increases oxytocin levels, which helps with uterine involution, reduces stress hormones, and aids in pain relief.

long-term benefits of skin-to-skin contact for an infant (5)

Boosted immune system, improved weight gain, stabilized metabolism, better sleep, and increased likelihood of breastfeeding for longer.

'Golden Hour' in the context of skin-to-skin contact

60 to 90 minutes of uninterrupted skin-to-skin contact immediately following birth

midwife's role in protecting uninterrupted skin-to-skin contact

Create a calm environment, avoid unnecessary touching or rushing, keep the baby on the mother's chest, and educate the whanau on its benefits.

key components of active management of the third stage of labour

Routine use of uterotonic drugs, controlled cord traction, and early clamping/cutting of the cord.

key components of physiological management of the third stage of labour

No routine uterotonics, allowing the cord to stop pulsating before clamping, and delivery of the placenta by maternal effort.

environment required for a safe/effective physiological placental birth

supports oxytocin release - such as dim lights, quiet, no stress, and no 'fiddling' or time pressure.

primary purpose of uterotonic medications

To increase the tone of the uterine musculature and expel contents from the uterus.

dosage/administration route for Oxytocin (Syntocinon) in the third stage

5IU or 10IU IM, or 5IU IV immediately after the birth of the baby.

common side effects of Oxytocin administration

Nausea, vomiting, hypotension, and tachycardia.

composition of Syntometrine

A combination of 5IU Oxytocin and 0.5mg Ergometrine maleate.

contraindications for the use of Syntometrine

Hypertension, preeclampsia/eclampsia, and cardiac, liver, or renal disease.

reason Ergometrine is avoided in breastfeeding mothers

It inhibits prolactin secretion, which can reduce lactation.

signs of placental separation during the third stage

Lengthening of the cord and a small bleed as the placenta detaches from the uterine wall.

correct procedure for Controlled Cord Traction (CCT)

Applying steady downward tension on the cord while providing counter-pressure suprapubically to the uterus.

Why must CCT never be used without a uterotonic?

It may lead to partial separation of the placenta and significant blood loss.

risk of not having skin-to-skin contact or breastfeeding within the first 30 minutes

Women are almost twice as likely to experience a postpartum haemorrhage (PPH).

midwife does if the placenta has not delivered within 30 minutes during active management

Consider further treatment or consultation; if there is no bleeding, observation for another 30 minutes may be appropriate.

recommended timing for delayed umbilical cord clamping

Not earlier than 1 minute after birth, with 3 minutes considered optimum or until the cord stops pulsating.

first-choice uterotonic for the prevention of PPH

Oxytocin (10IU IM or 5IU IV).

woman appears to have minimal bleeding after active management

Signs of haemodynamic compromise due to 'hidden blood loss'.

How midwife manages the membranes during placental birth

Assist the slow/trailing membranes by holding the placenta in two hands and gently turning it to twist the membranes, exerting gentle tension.

role of Tranexamic Acid (TXA) in midwifery

It is an antifibrinolytic agent (stops clots) that can be prescribed/administered by midwife.

done if bleeding becomes heavy after the placenta is delivered

Massage the uterus firmly until bleeding stops and consider the administration or repeat administration of uterotonics.