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Third Stage of Labour
- 1.Defined as from the time of birth to the expulsion of the placenta and membranes
- 2.Praise, congratulate on birth of baby/doing so well
- 3.Observe baby for colour, tone, breathing and record APGAR's at 1min, 5mins & 10mins. Enusre baby is warm
and wet towels are removed so as not to lose body heat
- 4.Skin to skin encouraged as it helps to regulate heart rate & temp
- 5.Would you like ACTIVE or PHYSIOLOGICAL third stage of labour? - Be supportive whatever her choice.
- 6.ACTIVE - Use of uterotonic drug, delayed cord clamping/cutting, delivery of placenta by CCT
- 7. PHYSIOLOGICAL - No utertonic drugs, delayed cord clamping, delivery of placenta by maternal effort
- 7.Observe physical condition, resps, how she feels, any vaginal loss
- 8.As oxytocin is released after birth, stimulated by skin to skin and through Intra muscular injection
in active management the uterus continues to contract
- 9.Recent recommendations support the use of delayed cord clamping in order to benefit the newborn. BENEFITS include - reduced respiratory
problems, ongoing placental oxygenation & aid transistion to extra uterine life and increase iron content to prevent anaemia & iron deficiency.
NICE, local trust guidelines and RCOG recommend cutting the cord after 2 minutes or until the cord stops pulsating
- 10.Top of the uterus walls fall against each other in aposition. There is a reduction in surface area and living ligatures squeeze the placenta giving it
nowhere to go. This encourages separation and expulsion. A textbook separation known as a Scholtz
- 11.Look for separation blees - A small gush or trickle - not continuous and cord lengthening. Guard the uterus to avoid prolapse and apply constant, firm traction on
the cord
- 12.When signs of separation are evident gently remove the placenta from the vagina, ensuring all visible membranes are
removed.
- 13.Change pads and sheets for comfort noting blood
loss
- 14.Inspect the perineum for trauma and tears. It is important to inspect the vaginal walls even if the perineum appears in tact. The woman should be informed/
consent given. The labia and clitoris also need to be inspected for tears and grazes and suturing completed if necessary. Taking extra care as the vagina and
perineum could be very sore and tender after delivery
- 15.I'd ensure that the woman and the baby are comfortable, call buzzer nearby and refreshments provided. Remove the placenta (to sluice) for
inspection
- 16.The placenta should be examined thoroughly to ascertain that it is complete as retained products can cause infection, prevent the uterus from invuluting and
heighten the risk of PPH
- 17.Starting from the cord check for arteries and 1 vein, moving along the cord, observe insertion into the placenta. Turning placenta over inspect
maternal side to ensure no missing tissue or cotyledons. Examine the mebranes - separate the chorion from the amnion. If the membranes and
ragged this must be reported as fragments may be retained in the uterus.
- 18.Estimate the bloodloss as accurately as possible
- 19.All documentation must be continuous and contemporaneous. All times must be recorded
accurately
- 20.Any deviations from the norm should be reported to an appropriate member of the MDT or action
taken
- 21.Once the placenta has been disposed of correctly, return to the woman and her family to observe any blood loss, weigh the neonate and initiate a feed if possible
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