Midwifery practice in the third stage of labour.




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De Montfort University


Thesis or dissertation

Peer reviewed


This thesis investigated practice variation among midwives during the third stage of labour. The study aimed to identify and explain the variety of ways midwives managed the third stage and to see if it was possible to identify midwife characteristics associated with different third stage management practices. Initially emphasis was placed on models of midwifery care in labour and the mechanism by which midwives developed expertise in third stage management.

A qualitative approach was used based upon the principles of grounded theory with the constant comparative method utilised to collect and analyse multiple types of data simultaneously.

Fifty one midwives employed in two NHS trusts were interviewed with the practice of a further seven midwives observed. An analysis of computer records also took place together with analysis of twenty eight editions of two midwifery textbooks published throughout the 20th century.

Multiple types of third stage management were described with inter and intra practice variation revealed among midwives. The complexity of third stage care was exposed through the identification of 22 aspects to third stage practice with between two and five care options available for each aspect.

A theory of contingent decision making for the third stage of labour was revealed which explained how midwives adopted different forms of care through a complex decision making process which was contingent on the learning opportunities midwives were exposed to, the context in which practice decisions were made and the philosophical underpinnings of midwifery care. Practice variation was explained within this multi-factorial framework.

The thesis highlights the difficulties in standardising midwifery practice and questions the validity of doing so. In this study practice variation in third stage care was a reflection of the individuality of midwives and the way midwives chose to individualise the care of women. In light of this a reappraisal of comparative studies in third stage management is needed together with an evaluation of the role of practice guidelines which attempt to standardise practice.





Research Institute

Centre for Reproduction Research (CRR)