MDWF 2030 Carter 4
MDWF 2030 Carter 4
MDWF 2030 Carter 4
Normally, after a brief resting phase after the birth of the baby, contractions resume, and the
placenta is delivered. The woman may feel a slight amount of pressure in the vagina that
precedes the birth of the placenta. After the placenta is delivered, the uterus clamps down and
bleeding from the placental site stops. (Frye, p. 371)
Indicated in low risk women.
Indicated for women who are a higher risk of postpartum hemorrhage (incidence of PPH is 5-
15%) and to shorten the third stage.
Women who may be at higher risk:
Large-bore IV line
Vigorous uterine massage
If these strategies do not succeed...
Bimanual compression
Additional uterotonic medication
Careful examination of the placenta for completeness
Tone
Trauma
Tissue
Thrombin
(Simkin, Ch. 7)
According to Frye, p. 514.....
Actively assist the birth of the placenta when:
First-degree tears include the vaginal mucosa, the fourchette, or the skin of the perineum just
below it. Repair.
Second-degree tears are deeper, mainly in the midline and extend through the perineal body.
Repair in layers.
Third-degree tears extend through the perineal body the transverse perineal muscle, and the anal
sphincter. Repair in layers.
(Oxorn-Foote, p. 399-403)
References:
Davis, E. (2012). Heart and hands: a midwife's guide to pregnancy and birth. Random House.
Frye, A. (2013). Holistic midwifery volume II: care during labor and birth. Portland, Oregon:
Labrys Press.
J. M., & Fahey, J. O., Gegor, C. L., Varney, H. (2015). Varney's midwifery. Jones & Bartlett
Learning.
Posner, G. D., Black, A. Y., Jones, G. D., & Dy, J. (2013). Oxorn-Foote human labor and birth,
6th edition. New York: McGraw Hill.
Simkin, P., Hanson, L., & Ancheta, R. (2017). The labor progress handbook: early interventions
to prevent and treat dystocia. John Wiley & Sons.