1. Managing the 3rd
Stage of Labor
Prepared by: Violeta Manalang-DeGuzman,MD,FPOGS
Bulacan Medical Center
Prepared on: January 31,2009
Presented by: Eva Felipe Dimog, RM, BSPH
University of La Salette
Santiago City

2. Objectives
 Define the 3rd stage of labor
 Enumerate the signs of placental
separation
 Describe the management of the 3rd
stage of labor

3. Third stage of labor
 Placental stage
 Usually last for 30
minutes

4. Managing the 3rd Stage of Labor
The following are signs of placental
separation except:
A. A gush of blood comes from the
vagina
B. Umbilical cord gets longer
C. Uterine fundus palpable beyond
the umbilicus
D. Uterus becomes round in shape

5. Signs of placental separation
 A gush of blood
comes from the
vagina
 Umbilical cord gets
longer
 Uterus rises over
the abdomen
 Uterus becomes
round in shape

6. Management of the 3rd stage of labor
 Expectant
 Active

7. Expectant management
 Talk to the woman
and tell her that
you will deliver her
placenta
 Wash your hands
and put on your
sterile gloves

8. Expectant management
 After having the signs of
placental separation, hold
the clamp close to the
perineum with one hand.
 Deliver the placenta by
putting one hand just
above the pubic bone.
 Tell the mother that she
can strain when there is
uterine contraction

9. Expectant management
 Gently guide the placenta
downward and outward by
holding on the cord.
 Be gentle because a hard
pull can tear or break the
cord and even worst, turn
the uterus inside out
 As the uterus stays in
place and the cord gets
longer , continue to guide
gently until the placenta is
delivered

10. Expectant management
 When the bulk of
the placenta is
out,hold it with
your two hands
 Rotate the placenta
like twisting a rope
until delivered so
that the fetal
membranes will
come out also

11. Expectant management
 Feel the uterus
from the abdomen
and massage it to
keep it contracted
 Inject an oxytocic
drug
intramuscularly

12. Management of the 3rd stage of
labor
 The best time to inject oxytocics
during the 3rd stage of labor
according to RA 7392 is
 A. After the delivery of the baby
 B. After the delivery of the placenta

13. Philippine Midwifery Act of 1992
(Republic Act 7392)
…..allows midwives to give oxytocics AFTER
delivery of the placenta and if they have
undergone training for it.

14. Active management of third stage
of labor
 Injection of
oxytocics after the
delivery of the
baby
 Controlled cord
traction
 Massage of uterus

15. Active management of third stage
of labor
 Requires proper learning and training
 Controlled cord traction may
accidentally break the cord or invert
the uterus when the placenta is
adherent
 Midwifery Act of 1992 (RA7392) only
allows midwives to inject oxytocics
AFTER delivery of the placenta

16. Key Learning points
 Wait for the signs of placental separation
prior to its delivery
 Do not pull the umbilical cord if it is still
attached to the uterus to prevent cord
breakage or uterine inversion
 Inject oxytocics only AFTER the delivery of
the placenta
 Always inspect the placenta for
completeness of membranes and
cotyledons.

17. References
 Elbourne DR, Prendiville WJ , Carroli G, Wood J, McDonald
S. Prophylactic use of oxytocin in the third stage of
labor.In: The Cochrane Library,Issue 3, 2003. Oxford.
Update Software.
 Joy SD, Sanchez-Ramos L, Kaunitz AM, Misoprostol use
during the third stage of labour. Intl J Gynecol Obstet
2003;82:143-152
 Prendiville WJ, Elbourne DR, McDonald S. Active vs.
Expectant management in the third stage of labour. In: The
Cochrane Library, Issue 3, 2003. Oxford. Update Software
 WHO, UNFPA,UNICEF, World Bank. Managing Complications
in Pregnancy and Childbirth. WHO/RHR/00.7,2000.
 Alejandro R. San Pedro, A Handbook on Postpartum Care, A
Clinical Guide on Care of the Mother and Newborn,
Philippine Midwifery Series Book 2, 2007