Thread by @midwifeingreen

Last week @Ldn_Ambulance and @KingsMaternity came together for some joint maternity training. Some of the learning may be useful for #communitymidwives and #ambulanceclinicians in London so I am writing up a thread 🧵

🧵 3rd stage of labour
Midwives' scope of practice: MWs sometimes give an oxytocic drug to aid birth of the placenta (active management)
This will be syntometrine or syntocinon depending on area/trust
This is followed by controlled cord traction (CCT)
Normally takes 5-30 mins

🧵 3rd stage of labour
Ambulance clinicians can instead use physiology to encourage this process (esp if MW not present)
- Encourage bladder emptying
- Use gravity/upright positioning (have something ready to catch the placenta!)
- Oxytocin helps! (Skin-to-skin, breastfeeding)

🧵 3rd stage of labour
Ambulance clinicians are recommended to convey to the nearest obstetric unit 20 mins following birth if placenta remains in situ because
a) not near obs theatre
b) can take time to leave scene
c) women can compensate well with concealed bleeding

🧵 3rd stage of labour
#Paramedics can give just one dose of syntometrine within 24 hrs of birth if concerned about bleeding.
#Midwives can give a 2nd dose if present.
Some MWs have misoprostal, others don't.
Paramedics can give TXA
Good to know for role delegation in #PPH

🧵 3rd stage of labour
When managing a PPH in the pre-hospital environment as an MDT, it is handy to know that #paramedics can cannulate, however they do not take bloods
- Good to utilise skill if establishing bi-lateral access
- MWs, if you want clotting/FBC/G&S, do the cannula

Those were the main learning points on this topic, please share with your #paramedic and #communitymidwife colleagues.
Quick reminder that recommended practice may differ slightly in other areas if in doubt check your local guidelines
#prehospitalmaternity