All of these things above are largely missing in a modern hospital environment which actually adds risk to postpartum hemorrhages. How?
Well, let’s now talk about how active management of the third stage is done.
Active management of the third stage involves giving a drug (a uterotonic, like Pitocin) to contract the uterus, clamping the cord early (usually before, alongside, or immediately after giving the uterotonic), and traction is applied to the cord with counter-pressure on the uterus to deliver the placenta (controlled cord traction). Active management was introduced to try to reduce severe blood loss at birth. This is a major cause of people dying in low-income countries where people are more likely to be poorly nourished, anemic, have little access to clean water and have infectious diseases. In high-income countries, severe bleeding occurs much less often, yet active management has become standard practice in many countries and it’s what we are accustomed to.
During active management in a hospital, we do everything that increases adrenaline and in turn increases postpartum hemorrhages:
❌unnecessary inductions causes the uterus to become overly exhausted and will have a difficult time contracting strong enough to release the placenta and shrink
❌sounds and lights are up to the max
❌strangers are vigorously rubbing baby and disturbing the bond
❌baby gets wrapped in blankets that disturb the skin to skin contact
❌the cord is pulled on immediately and forced to detach, even if it’s not ready
❌the umbilical cord can snap, leaving the placenta still attached and birther will have to undergo surgery to manually remove the placenta
❌forceful removal can cause postpartum hemorrhages because the placenta was not ready
NOT HAVING PATIENCE CAN BE DANGEROUS! THIS FORCEFUL SEPARATION CAN CAUSE DEEP WOUNDS, EXCESSIVE BLEEDING, BE EXTREMELY PAINFUL, MAY NOW NEED TO BE MANUALLY REMOVED AND CAUSE INFECTION TO THE UTERUS!
