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Position Statement

Role of the Midwife in Physiological Third Stage of Labour 

Model of Practice
ICM
Last Edited 1 June 2023 02:18 CEST
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Midwives check condition of a pregnant patient just before giving birth at Aiiku Hospital in Tokyo, Japan.

Background  

The third stage of labour is defined as the period from the birth of the baby until the complete birth of the placenta and membranes. The third stage is a time of adjustment. The woman is becoming a mother and adjusting to the hormonal, physical and emotional changes that follow birth. Her baby is adjusting to extra uterine life. Uterotonic drugs to help manage the third stage of labour are not always available, nor will all women consent to their use. The midwife should understand the nature of uterine contractions and the physiology of the birth of the placenta (or the third stage of labour), regardless of the place of birth or the cultural and social environment.  

The midwife’s role includes the regular assessment of the length of the third stage, placental birth time and process, monitoring of any blood loss and assessment of the general wellbeing of the mother and her newborn baby. The role of the midwife in the physiological birth of the placenta also includes providing information to the woman on the physiology of labour and birth and newborn adaptation to life.  

 

Position  

Many midwives will be required to attend the birth of the placenta without the aid of uterotonics and therefore the knowledge of physiological (expectant) care and management of the third stage of labour is considered a basic midwifery competency. As part of this competency, the midwife continuously assesses the woman for blood loss, any physiological effects of this loss and implements treatment measures if indicated. When a woman makes an active choice to experience a non-interventionist placental birth, the midwife will ensure the woman and her family have all the information necessary on which to make the decision.  

 

Recommendations  

This statement recognises the role and scope of the ICM Definition of the Midwife and the basic competencies that ICM expects of midwives. It also recognises the principle of autonomy and the notion of childbirth being a physiological process during which women and their families are entitled to information, choices and informed consent. Members are encouraged to ensure all midwifery curricula and ongoing education programmes include the role of the midwife in the management of the physiological third stage of labour as well as the active management of third stage.  

Related ICM Documents 

Nicole Byrnes, listens to her baby’s heartbeat, during a prenatal appointment with Indigenous midwife, Lulu Littler, at Minga Gudjaga Midwifery clinic in Nowra, Australia.
Core Document

Essential Competencies for Midwifery Practice

The Essential Competencies for Midwifery Practice outline the minimum set of knowledge, skills and professional behaviours required by an individual to use the designation of midwife as defined by ICM.
Position Statement

Partnership between Women and Midwives

Midwifery is based on a partnership between women and midwives with the goal of promoting health outcomes. Midwives should develop a partnership with women to actively share information and support women to actively participate in making decisions about their care.
A midwife Hotaru Tsuchida prepares to help with delivery at Aiiku Hospital in Tokyo, Japan.
Position Statement

Appropriate use of Intervention in Childbirth 

For most women, childbirth is normal, life event. Midwives should only use interventions during childbirth when these are necessary. All women should have access to quality are, including options for lifesaving interventions when they are needed.
Midwife Juliya Akter is doing Sathi Akter’s (22) pregnancy routine checkup. Her role involves monitoring the progress of labour, offering guidance, and facilitating a safe and positive birthing experience. She does routine examinations in the female ward and attends to newborn babies and mothers. Keraniganj Upazila Health Complex, Bangladesh.
Core Document

Definition of Midwifery

ICM has developed the definition of midwifery, used around the world as the basis of the profession.
Midwife Kemetra King performs a wellness check with patient Ari Eisenberg, who is nonbinary, at Choices clinic. Memphis, Tennessee, USA.
Position Statement

Midwifery: An Autonomous Profession 

ICM advocates global recognition of midwifery as an autonomous profession, rooted in unique knowledge, ethics, self-governance, and societal regulation.
Position Statement

Heritage and Culture in Childbearing

Midwives work in partnership with women and families to establish and maintain maternity services that are culturally sensitive, safe, and free from discrimination. Midwives should be knowledgeable about and respect the cultures of the families they work with.

Other Relevant Documentation  

Eddy, A., Begley, C. Fullerton, J. Guilliland, K. Kenndey, H. A 2009. Delphi Survey on the role of the birth attendant during a physiological third stage of labour. International Confederation of Midwives, Newsletter, 2009. 

 

Adopted at Glasgow Council meeting, 2008  

Revised at Toronto Council meeting, 2017  

Due for next review 2023 

 

PS2008_016 V2017