HiSue,
I can't quote scientific evidence on this, but as Michelle has also
experienced, when talking to American midwives, this is what I have
been told. I gather than some places have moved on to active
managements of 3rd stage. When reading the literature the timing of
the injection of Synto is not always mentioned, so it is hard to work
out exactly when the procedure was undertaken.
I have also come across the withholding of Synto until after the
placenta in some other countries as well, probably because American
ideas have been adopted (and perhaps not updated).
In past years when I have visited the US (and I admit that its been a
few years now) I felt that there was even less concern for evidence
based care than there is here at times. With no strong midwifery
profession (as distinct from nurse/midwives ) in hospital settings,
there didn't seem to be much questioning of routines, which were
largely determined by obstetricians habits and practises.
Judging from reading the journals etc (Birth for one) the importance
of using research evidence to underpin practise seems to have been
taken on board much more and no doubt this will change some
practises, as perhaps in this case with 3rd stage management.
Regards,
Andrea
At 04:24 PM 16/11/2006, you wrote:
Hi Sue,
I have also read and heard of this practice in America of giving the
synto after the placenta has been delivered. One of the
obstetricians who used to work here went to a conference over there
where they were discussing 3rd stage management. When she suggested
giving the synto before the placenta was delivered, she was
absolutely shot down in flames...... "everyone knows that giving it
before gives you retained placentas" !!!
Cheers
Michelle
----- Original Message ----
From: Sue Cookson <[EMAIL PROTECTED]>
To: ozmidwifery@acegraphics.com.au
Sent: Wednesday, 15 November, 2006 8:17:06 AM
Subject: Re: [ozmidwifery] Delaying synto with active 3rd stage
Hi Andrea,
I am not aware of the practice you have mentioned in America. Have you
any references for this?
Any idea what occurs if the placenta takes longer to arrive than the 20
minutes or so??
Sue
> Hello Sue,
>
> The question of third stage management has a cultural aspect as well.
> In the US, as far as I know, the syntometrine is not given until after
> the placenta arrives. It is then given to prevent excessive
> bleeding. Interesting to speculate on how this major difference
> developed, and why it is acceptable to wait the 20 or so minutes for
> the placenta to come physiologically in the US when it is unacceptable
> in the UK/Australia.
>
> Another one of those examples of how habit/routine becomes standard
> practice and is not questioned.....
>
> Regards,
>
> Andrea
>
>
>
> At 11:00 AM 14/11/2006, you wrote:
>
>> Hi,
>> I'm interested if there is any research on delaying synto for say up
>> to 5 minutes in 'active 3rd stage'.
>> Have been doing actively managed third stage throughout my clinical
>> placements as a student (nearly finished!!) with some practitioners
>> cutting the cord immediately, and most at about 10 - 20 seconds.
>> I've just prepared a powerpoint presentation on delayed cord clamping
>> but know I will get into a discussion around the seeming conflict
>> between active 3rd stage and delaying the clamping. Obviously if you
>> don't want the effects of synto's action - strong uterine contraction
>> with excess blood being pumped into bub, then you need to delay the
>> entire process of actively managed 3rd stage until the cord is clamped.
>>
>> Does anyone practice delaying the synto injection for those first few
>> minutes? Any evidence of harm in doing this?
>>
>> Thanks,
>> Sue
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