Management of the third stage of labour-focus group discussions with Swedish midwives

Objective: to explore Swedish midwives' experiences of management of third stage of labour. Design: six focus group discussions were performed and the analysis was based on content analysis. Setting: the midwives worked at six hospitals: three university hospitals and three provincial hospitals located from the south west to the north of Sweden. Participants: 32 midwives with extensive experience of assisting women in childbirth. Findings: the analysis generated three categories: 'bring the process under control', 'protect normality and women's birthing experiences' and 'maintain midwives' autonomy'. This study demonstrates that management of the third stage of labourvaries greatly. Not all midwives were convinced that administration of prophylactic oxytocin in the third stage of labour was always the besta lternative for all women who had a normal birth. Key conclusions and implications for practice: the midwives exhibite dself-confidence in evaluating the physiological process, and endeavoured to leave the physiological process undisturbed if no other risks were apparent. Their decisions concerning third stage management were based on a combination of previous experience, hospital guidelines, risk assessment and sensitivity to each woman's needs. This study demonstrates that management of the third stage of labourvaries greatly. The findings show the importance of reaching a balance between treating birth as a normal process and as a biomedical event. (C) 2008 Elsevier Ltd. All rights reserved.