Anxity during third stage

So today I’m 3 days post midwife at the birth of my wonderful clients on the morning of the June 9. Great Water Birth! My clients were truly very happy and amazed by the entire experience. From my prospective, if I had to truly be honest with myself, it could have been better (I could have performed much better as the midwife).
Let me start with saying I manage and over manage 3rd stage. I’m not sure why only to say that it may have been that El Paso training.. I had some sense of fear instilled in me when it comes to third stage of labor that I have yet to work through it. But whatever the reason I must over come and conquer this irrational need to get the placentas delivered.
The placenta and third stage let me recap my knowledge.
Mom delivers the ultimate prize package. Moms thrilled, she looks into the eyes of her newborn and marvels at the wonder of her accomplishments.
With pain of labor no longer present, quickly becoming a distant memory and those around her waiting on third stage to end, and if it is me, sensing a potential bleed.
OK it’s clear from that comment that I have a heightened sense of anxiety, and clearly lack trust in my ability to manage third stage 3rd stage or moms body to do what it is suppose to do.
Separation gush means that the placenta has started to detach, the bleeding generally stops as quickly as it started. Then the waiting begins. We wait patiently for mom to begin having contractions, this is an indication that the fundus is attempting to expel the placenta in earnest from the uterine wall. We may wait for cord lengthening then provide gentle cord traction (while guarding) if mom is laying supine, (Yes I do know moms who do not wish to squat their placenta out) or we may ask her to squat over a bowl to maximize her efforts
(I like a bowl because I can play with the blood loss and guesstimate how much, as can my apprentices). In either event if contractions don’t come then I get antsy if I know it has started to separate, wondering all the while where’s the blood. If you have a contracted uterus or one that is not yet contracting you sure better be familiar with how high that fundus is, feeling it is not fundus fiddling! As that uterus has been known to fill with blood while waiting for placenta, my perspective it that if you have more bleeding and more separation and no placenta then it is time to manage 3rd stage. I would do this by applying gentle cord traction (while guarding the fundus) Not that I really believe this is necessary mind you, but still for those die hard types I’ll add it. If I still had no placenta It pit time! With no bleeding or separation gush I can wait.
In the case of this particular client, she had that separation gush and here I go giving it cord traction with nothing more than a separation gush, nope I don’t even know if she was having a contraction. We get her to dry land tug a time or two then wait for a contraction, provide a little cord traction and viola, she delivers a dirty Duncan. Why all the premature pulling and tugging?
I can and do recognize this high anxiety I get during third stage I don’t like, my client sure as hell don’t like it, and maybe the whole aggressive behavior thing I do with the cord has simply become habit. Maybe I fear the big bleed so I rush this stage just so I can be done and breath again.
Ok so you’re asking yourself, wow how many bleeds have you caused? None! The few I have seen that were significant were the result of uterine atony, not the result of over managing third stage!
So my next birth, in about 3 week, will be a challenge. I will try to be more aware of this anxiety and use the physiological approach in the third stage.

Nadahfmidwife