Midwives’ Facilitation of Physiological Placental Birth: A Delphi Study

Deb Beatson
26 January 2021

Beatson, D. (2021). Midwives’ Facilitation of Physiological Placental Birth: A Delphi Study. (A thesis submitted in fulfilment of the degree of Master of Midwifery at Otago Polytechnic) [PDF 1941 KB]


In Aotearoa New Zealand (NZ), it is common for women to have a physiological placental birth (PPB) following a physiological birth. In this context, evidence suggests that PPB results in less blood loss than does active management, and a lower incidence of postpartum haemorrhage (PPH). However, there is minimal literature about midwives’ experience and knowledge about PPB.

The study aimed to uncover how midwives in NZ facilitate PPB. Objectives included reaching consensus about a definition of PPB and aspects of practice which support midwives to support women to achieve a PPB following physiological labour and birth. The research question explored was “what do midwives in NZ do to facilitate physiological placental birth, following physiological labour and birth?”. 

The Delphi technique, an iterative quantitative non-experimental survey method used for obtaining consensus of expert opinion on a topic was employed. The participants individually respond to the questions posed. The researcher reviews the expert responses and modifies the tool, which is then sent to the same participants, and the process of review and revision is continued aiming for 80% consensus.

Eighteen participants were recruited for their expert experience with PPB, with 14 continuing to the third and final round of the survey. The expert inclusion criterion employed was: Lead Maternity Carer midwives in NZ who provide PPB care for at least 30% of their caseload, and who have a postpartum haemorrhage rate of less than four percent (this based on the criteria used in the MEET study (Begley et al., 2012)).

The data was analysed using descriptive statistics with 13 resulting statements reaching consensus. These statements included a definition of PPB, factors which should be present or should be avoided in PPB, ways to facilitate PPB, and factors which influence decision making for supporting PPB. Four themes were generated following thematic analysis of the qualitative comments: understanding of and trust in physiology, supporting physiology (awhi), individualised care and continuous midwifery assessment. The importance of an upright maternal position, and methods of supporting physiology, particularly supporting the woman’s external environment, were highlighted. The technique of gentle cord traction (as opposed to controlled cord traction) to birth the placenta once it is in the vagina was endorsed by this group of midwives.

This distillation of midwives’ knowledge on PPB will add to the existing body of knowledge about placental birth. The findings are congruent with existing guidelines and models in NZ in the context of continuity of midwifery care and should give midwives confidence in the techniques uncovered.

Deb Beatson's thesis was supervised by Suzanne Miller and Jean Patterson.

Key words: Placenta; Physiological placental birth; Whenua; Midwives; Third stage of labour


This thesis is available under a Creative Commons Attribution-NonCommercial-NoDerivatives licence CC BY-NC-ND 4.0 International licence.