This month’s Essentially MIDIRS includes a thought provoking article about the third stage of labour by Denis Walsh.
Birth physiology and the third stage of labour by Denis Walsh
“Over the last 15 years, labour and birth physiology has been significantly rehabilitated from a position of being seen as unfit for purpose. Cochrane reviews now endorse labour mobility (Lawrence et al 2009) and upright posture (Gupta et al 2004) as efficacious for birth, whilst other randomised controlled trials support spontaneous pushing in the second stage of labour as opposed to coached pushing (Bloom et al 2006, Yildirim & Kizilkaya Beji 2008), and now there is explicit recognition that labour physiology is optimised by continuous support in labour (Hodnett et al 2009) and midwifery led care (Hatem et al 2008).
Despite these positive changes, which are reflected in national guidelines on intrapartum care, the tendency to medicalise pregnancy and birth remains with us. And if there is one area of labour and birth physiology where the tensions between routine intervention and letting nature take its course are hotly contested, it is the third stage of labour…”
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