Nursing Management of Third Stage of Labor

What Do You Mean By Third Stage of Labour?

Third stage of labor extends from delivery of the foetus up to the delivery of placenta and membranes. The part of labor from the birth of the baby until the placenta (afterbirth) and fetal membranes are delivered. The third stage of labor is also termed as placental stage.

Nursing management of third stage of labour
Fig: Nursing management of third stage of labour

Nursing Management of Third Stage of Labour:

Third stage is the most crucial stage of labour. Previously uneventful first and second stage can become abnormal within a minute with disastrous consequences.

Steps of management:

1. Expectant management (tradition al management):

  • Psycho logical support to the mother,
  • Monitoring maternal pulse and BP,
  • Delivery of the baby,
  • Clamp, divide and ligate the cord,
  • Wait and watch,
  • Catheterization of the bladder,
  • Guard the fundus,
  • Separation of placenta,
  • Wait for spontaneous expulsion with the aid of the gravity,
  • If fails, assisted expulsion is done by,
  • Injection Oxytocin 5-10 units slowly IV or IM,
  • If fails, controlled cord traction (CCT) and fundal pressure,
  • Examination of the placenta, membranes and cord,
  • Inspection of the vulva, vagina and perineum is done.

2. Active management:

a) Principle:

The underlying principle in active management is to excite powerful uterine contractions within one minute of delivery of the baby (WHO) by giving parenteral oxytocic. This facilitates not only early separation of the placenta but also produces effective uterine contractions following its separation.

The advantages are –

  • To minimize blood loss in third stage approximately to 1/5th and
  • To shorten the duration of third stage to half.

b) Procedure:

  • Oxytocin 10 units IM (preferred) or methergin 0.2 mg I/M is given within one minute of delivery of the baby (WHO).
  • The placenta is expected to be delivered soon following delivery of the baby.
  • If the placenta is not delivered thereafter, it should be delivered forthwith by controlled cord traction (Brandt-Andrevws) technique after clamping the cord while the uterus still remains contracted.
  • If the first attempt fails, another attempt is made after 2-3 minutes failing which another attempt is made at 10 minutes.
  • If this still fails, manual removal is to be done. Oxytocic may be given with crowning of the head, with delivery of the anterior shoulder of the baby or after the delivery of the placenta.
  • If it fails again then placenta should be removed manually.

[N. B. Controlled cord traction:

Upwards & backwards traction of the uterus with radial border of the hand over the symphsis and cord traction is given in a downward and forward direction.]

Nursing Interventions of Third Stage of Labor:

  • Administer oxytocin (IM or IV),
  • Inspect delivered placenta,
  • Monitor vital signs (g 15 minutes),
  • Palpate fundus,
  • Observe character and amount of lochia.

Non Pharmacologic Pain relief:

  • Relaxation,
  • Focusing on imagery,
  • Support from a doula or coach -Breathing techniques,
  • Bathing/ hydrotherapy : C/I in ruptured membranes,
  • Therapeutic touch and massage,
  • Hypnosis: deep form of relaxation,
  • Biofeedback: based on belief that people can control and,
  • Regulate internal events like HR and pain response,
  • Acupressure and acupuncture,
  • Heat or cold application.

Pharmacologic pain relief:

  • Local infiltration,
  • Pudendal nerve block,
  • Spinal anesthesia,
  • Epidural anesthesia.

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