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What is controlled cord traction and is it necessary?

What is controlled cord traction? If you haven’t researched your options and put your preferences on paper, it’s likely that you’ll be offered an actively managed third stage of labour to deliver the placenta. This involves using artificial oxytocin and controlled cord traction to deliver the placenta faster. But what does the research say about controlled cord traction and it’s perceived benefits?

The third stage of labour is the stage at which the placenta is birthed. There are two options for this. A physiological third stage, and an actively managed third stage. A physiological third stage doesn’t involve any medical interventions or drugs and relies on your body’s own oxytocin hormone to trigger contractions and expel the placenta. An actively managed third stage means early cord clamping, an injection of artificial oxytocin (syntocinon), pressure applied to the top of the uterus (the fundus) and controlled cord traction to reduce the risk of post-partum haemorrhage (PPH).

Controlled cord traction is the process of pulling the umbilical cord to encourage the placenta to separate from the inside of the uterus and be birthed sooner. This is a routine part of the actively managed third stage package, aimed at reducing PPH. However there are some risks, such as uterine inversion and cord rupture, if done incorrectly.

A Cochrane review of several studies looking at controlled cord traction found that there were no significant differences in severe post-partum haemorrhage when controlled cord traction was used versus when it wasn’t. It may reduce the risk of manual removal of the placenta, but this benefit disappeared when studies using a combination of oxytocin and ergometrine (syntometrine) were removed, and all of the studies only waited 30 minutes, so we don’t know if the placenta would have delivered naturally if a full hour was observed (which is typically how long it can take to naturally birth the placenta). The study concluded that controlled cord traction can be safely removed from the active management of the placenta delivery without increasing the risk of PPH.

It is vital that if you’re pregnant, you research your options, book yourself on a good face to face live antenatal (and hypnobirthing!) course, and spend time putting your birth preferences down on paper to go through with your midwifery team. Procedures like controlled cord traction will be performed routinely as part of an actively managed third stage (and an actively managed third stage will be performed if you don’t express a wish not to). If you’d like to get clued up on your options for birth, book on to one of my courses. Just contact me to find out availability!

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