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Physiological Third Stage of Labor; Is It Safe for Low Risk Women Hemorrhage (Pph).

Physiological third stage of labor; is it safe for low risk women hemorrhage (pph).

Evidence based research in third care refers to assiduous utilization of present best evidence in making decisions concerning patient care. The third stage of labor begins after birth and ends when the placenta is delivered (Jangsten, Mattsson, Lyckestam, Hellström & Berg, 2012). The third stage of labor is mainly uneventful, though considerable problems may occur during this stage. The most significant problem is the postpartum hemorrhage (pph) (Begley, Gyte, Devane, McGuire & Weeks, 2015). Although maternal mortality rate has dropped notably in the majority of the countries across the globe, pph is still a major cause of major cause of maternal deaths.

It is optional for one to have a physiological third stage or an active managed third stage. Physiological third stage includes waiting for the natural delivery of the placenta. After birth, the midwife delays the clamping of the umbilical cord to give room for oxygenated blood to throb to the baby (Mirandaet al., 2013). The uterus contracts and the placenta peels away from the walls of the uterus which later drops down through the vagina and can be pulled out. The baby’s cord is then held tightly and cut after the delivery of the placenta or after the cord stops pulsating. The placenta and the tissues are checked to make sure they are inclusive and no sections have been left in the body. Managed third stage is offered in various hospitals in different localities. The mother is given an injection on the thigh after the shoulders of the baby surfaces (Davis et al., 2015). After birth, the cord clamps and it is then cut. The injection leads to strong contraction of the uterus resulting to emergence of the uterus.

Research has reported that the major benefit of a managed third stage is that it leads to low cases of postpartum hemorrhage (Kramer et al., 2013). Immediately after birth and that chances of getting anemic in the near future are significantly reduced; however physiological, third stage is safe for women with lo low risk of pph. The method is natural and has no side effects. This paper seeks to assess physiological third stage and whether it is safe for low risk women pph. During normal birth processes, there should be convincing reasons to obstruct normal processions. Hence, it is not advisable to impose managed third stage on mothers who are at low risk of postpartum hemorrhage. Prolonged third stage increases the risk of heavy bleeding for individuals with high risk of pph. For mothers with low risk pph, the rate of heavy bleeding would not be affected despite the type of method selected for the third stage.


Begley, C. M., Gyte, G. M., Devane, D., McGuire, W., & Weeks, A. (2015). Active versus expectant management for women in the third stage of labour. The Cochrane Library.

Davis, D., Baddock, S., Pairman, S., Hunter, M., Benn, C., Anderson, J., & Herbison, P. (2012). Risk of Severe Postpartum Hemorrhage in Low‐Risk Childbearing Women in New Zealand: Exploring the Effect of Place of Birth and Comparing Third Stage Management of Labor. Birth, 39(2), 98-105.

Jangsten, E., Mattsson, L. Å., Lyckestam, I., Hellström, A. L., & Berg, M. (2012). A comparison of active management and expectant management of the third stage of labor: a Swedish randomized controlled trial. Obstetric Anesthesia Digest, 32(1), 44-45.

Kramer, M. S., Berg, C., Abenhaim, H., Dahhou, M., Rouleau, J., Mehrabadi, A., & Joseph, K. S. (2013). Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. American journal of obstetrics and gynecology, 209(5), 449-e1.

Miranda, J. E., Rojas-Suarez, J., Paternina, A., Mendoza, R., Bello, C., & Tolosa, J. E. (2013). The effect of guideline variations on the implementation of active management of the third stage of labor. International Journal of Gynecology & Obstetrics, 121(3), 266-269.