Another component of third stage requiring
consideration with respect to physiologic management is
the duration. There is some debate regarding the
maximum duration of a normal third stage. Third stage
usually lasts from 5-15 min, but may last up to an hour.4
After 30 minutes duration, there is an increase in the
rates of postpartum hemorrhage.60 Research has borne
out the association between prolonged third stage and
complications. It has been suggested that the most
important aspect of third stage management is
minimizing its duration, and that how this is
accomplished is secondary. For example, in two trials
demonstrating active management to be the superior
approach, 26% and 16.4% of women in the physiologic
groups had third stages exceeding 30 minutes
(compared to 2.9% and 3.3% of women in the active
management groups).22,26 In another trial, which
demonstrated no benefit to active management, third
stage duration was less than 20 minutes in 93% of the
physiologically managed and 95% of the actively
managed groups respectively.23