Back in June, I wrote about a theory paper by Australian researchers that I read that discussed the limits of current research literature that does not compare medically managed bith with truly "psychophysiological" birth, meaning unmedicated birth without routine interventions, in a comfortable setting with supportive care. This means that you can't compare the third stages of an actively managed hospital birth with a hospital birth where oxytonics and cord traction are not used, but other hospital factors are included--such as early cord clamping/separation of mother and baby, distractions, stressful atmosphere, IV fluids, unnatural positioning, etc, and claim that "expectant management doesn't work." The article proposed research that could be done comparing what they called "midwifery guardianship" with "active management."
I just learned today (thanks to Birth Sense) that the Australian researches who wrote the theory paper have completed a study on third stage management. The abstract is available here, and the results are very interesting! The study found that for low risk women, active management in a hospital was actually associated with a significantly higher rate of postpartum hemorrhage (11.5%) than the rate they found for midwife-led "holistic physiological care" in a freestanding birth center (1.7%). Considering that previous studies had found the risk or hemorrhage using other definitions of "expectant management" to be higher, these findings are important for determining what factors are necessary for a safe, natural third stage.