Natural or managed third stage

[iwishiwasalittlebitfitter]

I heard that the new trend is to have a natural third stage which give more blood to the baby and can help avoid jaundice.

What's your experience?

Hi, I've had two managed third stages and one natural... I'd heard the same as you. Now expecting DC4. After the natural third stage I had a big bleed so this time going back to managed.

Posted too soon so just typed longer message and lost it aaagh
Can ask MW to delay clamping cord until it stops pulsating, good for baby
No idea 're jaundice, all mine have had a mild case, linked to breast feeding
Suggest you chat to MW x

I wanted a natural third stage originally, but after a completely exhausting labour they asked what I wanted and I went for a managed third stage. I just wanted it all over with tbh.

The MW on the antenatal ward kept saying she thought DD had jaundice but every time they did the test (we were in for a week) she didn't.

This time I will most likely be going for another managed third stage but waiting for the cord to stop pulsing, assuming all is well etc.

I didn't realise there was a link to jaundice. My first was managed because I was knackered and had epidural and I actually don't think the asked me what I wanted. DS1 had jaundice.

My second was a home birth and natural third stage. Lay holding DS2 for about half an hour then they asked me to squat and , one quick squeeze later, the placenta was out. DS2 didn't have jaundice.

Not sure that my two examples are enough to prove/disprove the jaundice link though! Second birth was a million times nicer though.

I wanted natural, waited for cord to stop pulsating, held DS for half an hour, pushed and no placenta, mw wanted to give me injection so I agreed. Another half hour and a lot more painful pushing and placenta eventually came out. Would go for natural again though.

It's not a "trend", it's based on research

I think whether you have one or not depends on how the birth goes. If all goes simply, without intervention then by all means. If not, if there's forceps or whatnot, I think it's recommended to have a managed 3rd stage.

Forgot to say, I had a natural 3rd with DS1, 8 years ago. He latched on within minutes of being born and that aided the delivery of the placenta within an hour. It's important that you are kept warm whilst you're waiting to deliver the placenta.

The MW must not use cord traction or interfere manually in any way. It's a matter of watch and wait for your body to do what comes naturally.

After the placenta was delivered, the MW felt my abdomen to make sure my uterus was shrinking down, and she monitored my blood loss.

Sweet tea and toast helps at this point too, as does quiet and warmth.

God sorry to keep posting - preggo brain

Forgot to add that the cord was not cut until AFTER the placenta was delivered, and the cord stopped pulsating and went white.

I had managed, but waited several minutes before clamping cord. Both mine had jaundice, and I think that delaying clamping does increase the risk of mild jaundice, but the benefits of the extra blood, which greatly increases iron deposits up to 6m, outweigh the jaundice risk iirc.

I'm pregnant with my first, planning a homebirth and was going for a natural third stage. But that awful story in the news about the poor woman dying at home because of how her placenta came out/part of it being retained, has a me a bit worried

I think I need to do some research into what a managed third stage is "supposed" to be like versus a natural stage, and then maybe if something different happens we can at least ask questions.

Argh, all this sudden anxiety!

The MW in that case should not have pulled on the cord to get the placenta out.

Cord traction is used in a MANAGED third stage after the synto injection has been given. NOT in a natural 3rd stage. In a natural 3rd stage, the MW needs to keep her hands off until the placenta is out. Cord traction, especially if she's rough, can cause the placenta to break.

After the placenta is out, it must be thoroughly inspected to ensure all the parts are intact, and none have been retained. There are two lobes to a placenta, the cord, and the membranes. The MW should inspect that the membranes have all been passed. She should perform this inspection in front of you and show you your intact placenta. She should monitor you closely for further blood loss and ensure it is of a minimal/safe amount.

It is worth mentioning that you could have a natural delivery of the placenta, delayed cord clamping, AND THEN have the synto injection after the MW is satisfied the placenta has been entirely delivered. The synto would aid your uterus in shrinking and could provide the reassurance you need that your blood loss will be minimal.

Also worth noting: in either a managed or natural 3rd stage it is VITAL that the MW is competent enough to check and ensure that all of the placenta has been passed.

That story is tragic, but it was negligence, not the fault of a natural 3rd stage per se.

Thanks Badgerina - that was very clearly explained, and very helpful!

After reading a lot of research i decided i wanted a natural third stage. i had a watrrbirth at home with my dd1.

After the gorgeous little water baby arrived, we realised there was a considerable tear and lots of blood - the mw allowed the cord to stop pulsating (she commented it was the quickest she'd ever seen) but wanted to stem the bleed so i was asked to leave the pool and given the injection.

This was defo the right decision at the time, it wasn't what i had planned for but events take there own course... as it was there was only a second degree tear (it looks worse in water!) and the placenta delivered very quickly and looking perfect. for me the most important thing was that my baby got all the goodness, which as i made it clear to the mw this happened!

No jaundice here, scored 9 on the apgar within 5 mins and scored 10 at the next check. good luck and enjoy it!

Have just come back to this thread and seen the other posts. In my natural third stage the MW did use cord traction, shocked that this may have caused the post partum bleed. Suggest if you do go for natural third stage you go in fully informed....