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7 Comments
The video says that active labor starts at 4cm. That actually changed 10 years ago and is now defined at beginning at 6cm. This is important as it changes when a hospital defines failure to progress and lowers the chances of having a c section or other interventions when what someone really needs is more time.
The Pause, really well explained by the Midwife Whapio. She has seen one lasting for 8hours… I have personnaly experienced a 5hours Pause for my first.
May be judicius to precise that it can accually last hourS.
I’m a hospital midwife in a rural regional hospital and have delivered somewhere between 700-800 babies. I can tell you I routinely support physiologic birth in low risk patients, support the natural pause, and it most often is pretty brief in nature. I have hardly ever needed to add pitocin for that physiologic lull. We do sometimes have fetal considerations that aren’t addressed here – not uncommon to have big decelerations at this time, which may lead to providers rushing things.
It is all of our standard practice to do delayed cord clamping and it has been for years.
For certain patients with risk factors, I also perform active management of the third stage which includes gentle cord traction with the placenta. This is actually taught in midwifery school, and not necessarily a sign of “impatience.” Evidence is varied but in practical experience this actually reduces risk of hemorrhage in my higher risk patients. In my view, the most protective I can be of golden hour means to prevent unnecessary bleeding postpartum. I have never once had an inversion or prolapse and this is because when it is done with proper training, you anchor the uterus with the non-dominant hand. I’m sad to see so much negativity expressed here in relation to practices that I have seen keep people safe, especially those cases of patients with more medical complexity who may be risked out of home birth.
Kristen, Thank you for your comment and skill and sharing your knowledge with us. I understand that midwifery practices vary significantly and everyone’s skill level is different. I love your approach and thank you for sharing it. This comment is from the several experiences I’ve had with clients postpartum where the technique was not done as you say and has resulted in prolapse. I don’t feel OB’s are taught with the same level of skill and respect to the tissues as midwives. Thanks for sharing.
The video says that active labor starts at 4cm. That actually changed 10 years ago and is now defined at beginning at 6cm. This is important as it changes when a hospital defines failure to progress and lowers the chances of having a c section or other interventions when what someone really needs is more time.
Thanks for the update Emma. I missed this in my research. Glad they are giving moms more time!
Hospitals have mostly now adopted DCC for 60 seconds, with some providers and parents preferring waiting until white or 2-5 min
The Pause, really well explained by the Midwife Whapio. She has seen one lasting for 8hours… I have personnaly experienced a 5hours Pause for my first.
May be judicius to precise that it can accually last hourS.
Thanks for sharing Naima! That is a LONG time to pause. They won’t let that happen in a hospital birth.
I’m a hospital midwife in a rural regional hospital and have delivered somewhere between 700-800 babies. I can tell you I routinely support physiologic birth in low risk patients, support the natural pause, and it most often is pretty brief in nature. I have hardly ever needed to add pitocin for that physiologic lull. We do sometimes have fetal considerations that aren’t addressed here – not uncommon to have big decelerations at this time, which may lead to providers rushing things.
It is all of our standard practice to do delayed cord clamping and it has been for years.
For certain patients with risk factors, I also perform active management of the third stage which includes gentle cord traction with the placenta. This is actually taught in midwifery school, and not necessarily a sign of “impatience.” Evidence is varied but in practical experience this actually reduces risk of hemorrhage in my higher risk patients. In my view, the most protective I can be of golden hour means to prevent unnecessary bleeding postpartum. I have never once had an inversion or prolapse and this is because when it is done with proper training, you anchor the uterus with the non-dominant hand. I’m sad to see so much negativity expressed here in relation to practices that I have seen keep people safe, especially those cases of patients with more medical complexity who may be risked out of home birth.
Kristen, Thank you for your comment and skill and sharing your knowledge with us. I understand that midwifery practices vary significantly and everyone’s skill level is different. I love your approach and thank you for sharing it. This comment is from the several experiences I’ve had with clients postpartum where the technique was not done as you say and has resulted in prolapse. I don’t feel OB’s are taught with the same level of skill and respect to the tissues as midwives. Thanks for sharing.