Push, pull, squeeze, clamp: 100 years of changes in the management of the third stage of labour as described by Ten Teachers

The third stage of labour (between the delivery of the baby and the placenta) is the most dangerous time of childbirth for the mother. Many of today’s obstetricians were taught that “active management” of this stage (oxytocics, early cord clamping, and controlled cord traction) was the only safe way to deliver the placenta. Recent studies have shown that although prophylactic oxytocics are beneficial, early cord clamping is of no benefit (and could be harmful) and controlled cord traction has little benefit.1 We sought to place these changes in context through a historical study of obstetric practice over the last century.

The undergraduate textbook Obstetrics by Ten Teachers has been a favourite with students for many generations. First published in 1917 as Midwifery by Ten Teachers,2 the book was renamed in 19663 and is now in its 19th edition. Each edition is written by 10 leading obstetricians from the British Isles with the authors chosen by the senior editor. With a complete absence of references in the text, the series provides an excellent example of “eminence based” medicine and gives an insight into changes in labour ward practice over the past century.

We reviewed the regimens for the third stage of labour between 1917 and 2011 as described in the successive editions of the books. Copies were obtained from the University of Liverpool’s Harold Cohen library and from interlibrary loans as necessary.