Changing the focus for the third stage of labour

Abstract

This paper suggests that midwives re-evaluate management strategies for the third stage of labour and reflect upon the widely-held belief that intervention at this time is an improvement on the normal physiological processes and is without risk. Midwives are challenged to embrace a normal rather than a risk focus in light of support from WHO, who suggest ‘definite conclusions about the value of active management of the third stage in healthy low-risk populations cannot yet be drawn’ (WHO, 1999). If midwives are to face this challenge they need to be proactive in normalising the third stage, developing expertise in expectant management and revisiting skills in detecting those women deviating from normal in whom an active third stage may be appropriate.