I finally have some pictures of our workshops.
Here is some of us just chatting as midwives often do
This week was the third stage, We did roll play of active management, physiological management and lotus. We had discussions around custom practice and reality surrounding each. We looked at all the research and took it apart. We talked through emergency at home with birth of the third stage and of course we had some placenta’s kindly donated for us to look at and take prints.
Fun with Physiological third stage
Lotus among friends
Here is a collage of the placenta's and prints we made
This is the most recent research done on third stage in New Zealand just last year.
Guilliland, K. (2007). The current global effort to prevent post partum haemorrhage: how likely is it to be effective? New Zealand College of Midwives Journal, 36, 28-31
In New Zealand about 30% of all women, with a midwife lead maternity carer (LMC) who is a member of the New Zealand College of Midwives’ Maternity Provider Organisation (MMPO), have physiological management of third stage of labour (NZCOM, 2007). The women choose this option as a result of the informed consent culture in New Zealand. This allows them to assess their own risk and make their own decisions about care.
Out of a total cohort of 12,061 women cared for by 369 midwives in 2004, the rate of PPH in those 30% of healthy women (who chose physiological management) was lower than that of the healthy women who chose active management (ibid).
In NZ most women start their pregnancy with an LMC and some 78% in 2003 had a midwife LMC. (Ministry of Health, 2006). It is common therefore for midwife LMCs to have a mixed caseload of low to moderate risk women. They either provide care for these women on their own responsibility or they work in consultation with specialists.
The incidence overall of PPH following vaginal birth in the MMPO 2004 cohort of mixed low to moderate risk status women was 8.3%. Of the women who chose an actively managed third stage, some 6% had a PPH of between 500 and 999mls, compared to 3% of women who chose a physiologically managed third stage. Some 1% of women in the actively managed group had a PPH over 1000mls. No women in the physiologically managed group had a PPH over 1000mls. Manual removal of the placenta was required for 0.4% of the women, and this was the same rate in both groups. The main incidence of PPH in this cohort, and in New Zealand in general, was not following spontaneous vaginal birth but was predominantly associated with operative birth both
forceps and caesarean section (Women’s Hospitals Australasia, 2005).”
And Finally our thank you to the wonderful hosts who put up with the midwives showing vaginas, blowing up birth pools and examining placentae with no complaints. Presented to them at the end of the night.
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Wow, great photos Lisa!
Seriously, thank you so much for doing these workshops, they were brilliant! Also it was a fantastic opportunity to expose holistic midwifery care to some current midwifery students who are at risk of never learning about the art of midwifery just the medicalisation of it.
You are an inspiration to us all – women, mothers, midwives, students. Thank you for being true to yourself and true to birth.
Bless you, you gorgeous woman.
Love,
Luci
xx
OOPS I forgot to say Luci took the pictures, Thanks Love.xx
Hi Lisa,
What is the orange/yellow powder, tumeric?
Is it to help with the prints or for something else?
Grant
It’s Tumeric and that was to add colour as one of the placentae had been frozen and they are usually more watery and difficult to print.
I wish I were in your part of the world and able to attend these fabulous workshops.
Now I have a question. On average, how long does it take for the placenta to be born in a physiological 3rd stage? I feel this lore is lost due to the active management everywhere.
Thanks Lisa.
Hi, placenta can take anything from few mins to a few hours. As long as there is no bleeding and the woman is well you can just wait.
I have had this philosophy of just letting the placenta come out when it is good and ready. One time I got talked into trying active mgmt where you start pitocin IV just after the baby delivers. I knew it wasn’t right in the pit of my stomach, but I got talked into as I said. Wouldn’t you know it, the cervix clamped down on that placenta and trapped it. I had to go in and manually remove it. That was the end of my active mgmt of the placenta. I told the person who talked me into the active mgmt I thought it was crazy to do that and I was just going to let the woman’s body let go of that thing when it was good and ready. I havnen’t had that problem again, and the reasons for any hemorrhaging I have had have nothing to do with placental management! So amen sista.
Thetravelingmidwife.blogspot.com
P.S. love your blog!
Hi Lisa,
Just wondering about the NZ research – I wonder what percentage of these women had no pitocin/syntocinon or any other drugs in labour, and STILL went on to have a physiologic 3rd stage. IE, did they manage to have a natural 3rd stage even in spite of earlier pitocin/other drug use ? Were they truly allowed free “choice” in the matter ? In North America, active management is the norm, absolutely, if only because of the high use of pitocin and other narcotics in labour. I wonder if in NZ, the rates of use of pitcon augmentation, etc. are much lower than here, where having a physiologic 3rd stage is actually contraindicated, if you’ve had any of the above…
Thanks in advance for any light you you can shed.
Hi, I’m not in New Zealand myself but have made a few enquires re your question. I’ll get back to you.