It is important to acknowledge that there is variation in the preferences of both midwives and women regarding third stage management. Woman and midwives who participated in the Bristol trial on active management of third stage both regarded the longer length of third stage with physiologic management as a negative feature,63 and research suggests there is a tendency to favour active management. Others favour physiologic management because it is “less interventive,” though it has been suggested that the label of interventive medicine should be removed from the evidence based practice of active management. Midwives are in a position to preserve choice by respecting that some women neither want or need active management while presenting evidence based information to all clients.20,65 It is the role of midwives simultaneously to support birth as a natural physiological practice and to acknowledge the research that supports interventions such as active management in decreasing postpartum blood loss.