Irish and New Zealand midwives' expertise in expectant management of the third stage of labour: The 'MEET' study

Objective: to explore the views of expert midwives in Ireland and New Zealand of the skills they employ in expectant management of the third stage of labour (EMTSL). Design: university ethical approval was granted for a qualitative descriptive study in 2010. Recorded, semi-structured interviews were undertaken. Constant comparative analysis was used. Setting: community birth settings in Ireland and New Zealand. Participants: 27 consenting midwives who used EMTSL in at least 30% of births, with PPH rates less than 4%. Findings: the majority of respondents believed the third stage was a special time of parent-baby discovery and 'watchful waiting', with no intervention necessary. Great importance was placed on women's feelings, behaviour and a calm environment. Skin-to-skin contact, breast feeding, not clamping the cord, upright positions and maternal effort, sometimes assisted by gentle cord-traction were also used. Key conclusions: some components of EMTSL identified by these expert midwives are not recorded in text-books, but are based on experience and expertise. These elements of EMTSL add to midwifery knowledge and provide a basis for further discussion on how normal physiology can be supported during the third stage. Implications for practice: use of these elements is recommended for women who request EMTSL, and for those in countries without ready access to uterotonics.