September 08, 2003

Managing third stage?

I am in Orange today, presenting an Active Birth workshop. This is a very rural area in NSW, with a number of small midwifery units serving a shrinking population of young families.

We had an interesting discussion about the management of third stage. Most of this group are very experienced midwives, and many have worked in this area for many years. They are open to new ideas, but struggling with doctors and their often old-fashioned (read non-evidence based) ideas that are designed to keep them firmly in control. We talked at length about the management of the third stage of labour and some found the issue uncomfortable - the State Department of Health instructs midwives to cut and clamp the cord immediately after birth, so why should they challenge this?

Syntocinon is given routinely in this area, as it is many other places. The idea that parents might even be consulted on how they want the placental birth managed was surprising to many, yet they were concerned about the issue of litigation which they felt was driving many of the routines that are being put into place by the doctors. When I suggested that to give drugs to speed up the 3rd stage, without informed consent from the woman, might leave staff open to charges of acting without parental permission, some in the group were surprised - they had not thought about this at all.

While we were on the topic, we discussed when to cut the cord (not until after it has stopped pulsating and once that happens it can be cut at any time - even left...) and we even ventured into the realms of Lotus Birth (that caused a stir!). We explored the mechanisms of physiologic third stage, an event with which the majority were unfamiliar, and looked at the impact of oxytocics during birth and problems with initiating breastfeeding, including the increased likelihood of the baby developing jaundice. We also talked about what happens when a very tight cord is left rather than cut to facilitate birth. This was an eye-opener for many, but there were several midwives who had seen how a baby is able to get itself born safely, even when tangled in its own cord - a safer option than cutting, which leaves the baby without a life support system.

Much of this was news to these midwives, illustrating how isolated they can become in rural areas, where they have only the doctors to inform their practice.

One issue we won’t be discussing tomorrow is water birth. There are few baths available and these midwives have little interest in obtaining them. I will show them a water birth video clip because, as one midwives stated, they need to have their horizons broadened.

It has been a mixed day - much of what we explored is familiar territory for these experienced midwives, yet there are whole areas of practice with which they are unfamiliar and even disinterested. Quite a change from my usual groups! More tomorrow.....

Posted by andrea at September 08, 2003 08:54 PM

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dear Andrea, just read your entries whilst in Orange, I hoped that we weren't that disinterested!!- but yes we are inhibited largely by the policies of both the health department and hospitals, along with doctors. But we CAN make a difference in our own practice, and as you said, we as the caregivers spend much of our time alone with our women, and can effect the outcomes very much! Loved the workshop!

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