Irish and New Zealand midwives' expertise in expectant management of the third stage of labour: The ‘MEET’ study

Abstract

Objectiveto explore the views of expert midwives in Ireland and New Zealand of the skills they employ in expectant management of the third stage of labour (EMTSL). Designuniversity ethical approval was granted for a qualitative descriptive study in 2010. Recorded, semi-structured interviews were undertaken. Constant comparative analysis was used. Settingcommunity birth settings in Ireland and New Zealand. Participants27 consenting midwives who used EMTSL in at least 30% of births, with PPH rates less than 4%. Findingsthe majority of respondents believed the third stage was a special time of parent–baby discovery and ‘watchful waiting’, with no intervention necessary. Great importance was placed on women's feelings, behaviour and a calm environment. Skin-to-skin contact, breast feeding, not clamping the cord, upright positions and maternal effort, sometimes assisted by gentle cord-traction were also used. Key conclusionssome components of EMTSL identified by these expert midwives are not recorded in text-books, but are based on experience and expertise. These elements of EMTSL add to midwifery knowledge and provide a basis for further discussion on how normal physiology can be supported during the third stage. Implications for practiceuse of these elements is recommended for women who request EMTSL, and for those in countries without ready access to uterotonics.