This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
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This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
It is protected under the UK and international law of copyright.
Physiological 3rd Stage
Reflection
At handover we were told about a para 1 lady having an imminent water birth and I really hoped I could attend it. Sister asked was going to send me into another lady but asked if I could go to the water birth as I had never seen one and was really excited at the prospect of this. Sister thought that my mentor and I would perhaps be too late but sent us in anyway.
Luckily when we arrived she hadn’t delivered, however she was out the pool, as she was getting really uncomfortable and wanted some opiod analgesia. Her labour was progressing well and although I was disappointed at not being involved in a pool delivery I thought that I could still get a normal delivery. The pool delivery would have to wait for another time on this occasion.
Mum wanted to have as natural a delivery as possible although she wanted to have morphine for the pain.
She was leaning over the bed and was starting to bear down and the head was visible in the distance at the height of her contraction. She wanted on to the bed and got into an all fours position and had her injection.
I got myself prepared and was looking forward to an all fours birth as I had just delivered my first one the day before and felt that I would manage this much better and consolidate my previous experience.
The second stage wasn’t very long and mum soon delivered a healthy baby boy. She turned to a sitting position to nurse her son.
Mum had unfortunately had a traumatic birth with her first child, which resulted in retained placenta and an operative procedure for removal, this had tainted her otherwise natural birth. Mum was really concerned about it happening again this time so she wanted to try a physiological delivery of the 3rd stage, which she decided on after discussion with her community midwife and GP.
I had never witnessed this and was a bit unsure of the process or what my role was. My mentor told me to feel the cord till it stopped pulsating then to clamp and cut the cord.
I thought I still had to use some controlled cord traction when I saw the signs of separation, but my mentor said no just to wait. As the cord lengthened I moved the clamps up but had to keep reminding myself not to put any effort on it.
Mum was quite worried the whole time that there was going to be a repeat of her last delivery and I was getting worried as I didn’t really know how long it should take. I thought about 30 minutes but after 30 minutes there was still no sign of it. My mentor asked mum if she could push when she got a contraction, after trying this a few times there was still no sign of it so mum tried baby at the breast to see if that would help, but again it didn’t.
After an hour my mentor told mum that she would have to consult the doctor. He did a vaginal examination and found the placenta just sitting inside the vagina and so was able to lift it out.
Both mum and dad were delighted by this, as they had been getting very concerned that mum may have to go to theatre again and were so relieved that nor surgical procedures were needed.
Because I didn’t know much about physiological 3rd stage I read up on it and discovered that a change in position may have been all that was necessary for the placenta to deliver with out any interventions. Initially I thought mum could have been supported in a squatting position but I have since found out from the Cochrane review that this can lead to an increased chance of bleeding and possible haemorrhage.
However if mum had remained in the all fours position she gave birth in then it was more likely she would have delivered the placenta more easily and quickly and additionally it would be easier to see if there was excessive blood loss (McDonald 2003).
This also raised my awareness of the use of uterotonic drugs and highlighted the Bristol and Hinchingbrooke trials I had previously looked at.
For mum she had a satisfactory outcome and indeed was grateful she did not require surgery. However I wished I had thought about her positioning beforehand. Although I am now much more aware of this it was unfortunate that neither myself, my mentor or the doctor had thought about position changing to aid the procedure. Nevertheless I will know how to deal with a physiological 3rd stage in the future and indeed have the knowledge of both physiological and active to truly offer women informed choice of their 3rd stage management.
last updated 05/06/07
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