Nikki wrote:
After reading the HOOP trial I was frustrated that they did not seem to provide enough information to determine why it was that the hands poised group had a significantly higher rate of manual removal of placenta. I can't think of any reason why this would be so - unless the midwives caring for these women were applying a different type of care for the third stage, either consciously or subconsciously, to the hands poised group. If they were providing different care, why was this? Perhaps a different subconscious attitude towards this type of care? Or something they were uncomfortable with? And if so, how did that affect other aspects of the trial?
I feel sure that this outcome (higher rate of manual removal) is due to the time limits placed on the management of the third stage. If the hands are poised then maybe it follows that routine syntometrine is also slower or that contolled cord traction is delayed. It is another very unsatisfactory aspect of this trial..... not enough information is given. In the UK a delay in the third stage beyond 15 - 30 minutes will most likely lead to an automatic manual removal.... patience is at a premium here. The idea of waiting for the placenta (at all) was greeted with amazement in the workshops Lynne Staff and I have just concluded....
Regards,
Andrea
----- Andrea Robertson Birth International * ACE Graphics * Associates in Childbirth Education
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