Active Management - drugs for third stage
'Active management', or a 'managed third stage', means that you have an injection as the baby is born, or shortly afterwards, which makes your uterus contract strongly to push out the placenta quickly, and then makes it clamp down tight to reduce bleeding after the placenta is delivered. In the UK, the drug most often used is Syntometrine - a combination of Syntocinon, to bring on strong contractions, and Ergometrine, to make the uterus clamp down tight afterwards.
The
advantages of an actively managed third stage are that the third stage is usually over quickly, and average blood loss is lower. The mother does not usually have to 'do' anything - she just waits, while the drugs and the midwives do the work!
The
disadvantages of an actively managed third stage for the
mother are:-
- some women feel sick, dizzy or faint or have a headache after the drug is injected, and some vomit and are unable to hold the baby for a while after birth because they feel so bad. Estimates of the proportion of mothers so affected vary from 1 in 8 to 1 in 3, so while the majority of mothers will feel fine after Syntometrine, the risk of 'minor' side-effects is appreciable.
- Blood pressure changes can be significant for some women -
- There is thought to be a higher risk of trapped placenta, where the placenta is stuck inside the uterus, if it is not delivered before the ergometrine component of the drug makes the uterus clamp down. If a trapped placenta occurs, it usually has to be manually removed in an operating theatre.