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A review of third stage of labour care guidance

02 October 2021
14 min read
Volume 29 · Issue 10

Abstract

Introduction

Concerns exist regarding the suitability of national and international guidance informing third stage of labour care for women at low risk of postpartum haemorrhage.

Methods

The robustness and appropriateness of the research evidence underpinning third stage of labour care guidance by institutions such as the National Institution for Health and Care Excellence, the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives was assessed and areas for further research to address any gaps in knowledge were identified.

Results

National and international third stage of labour practice guidance recommend active management for all women. This may not be suitable for women at low risk of postpartum haemorrhage giving birth in a midwife-led unit or a home birth setting. This is because of the reduced reliability, validity and generalisability of the evidence informing this guidance to this group of women.

Conclusions

Expectant management may be more appropriate for women at low risk of postpartum haemorrhage who choose to birth in a midwife-led unit or home birth setting and want to experience a birth with minimal intervention. However, more research into third stage management practices in these settings is needed.

Labour is traditionally divided into three artificial stages. The first stage consists of the woman in labour experiencing regular, painful contractions, with progressive cervical dilation from 4 cm until fully dilated at 10 cm. The second stage continues from when the woman's cervix is fully dilated until the birth of the baby. The third stage is the period of time between the birth of the baby and the delivery of the placenta and membranes (National Institute for Health and Care Excellence (NICE), 2017). There is always some blood loss during this third stage, and healthcare professionals' care aims to reduce excessive blood loss. In clinical practice, care is managed by two distinct clinical approaches: active management and expectant management, often referred to as physiological management (Begley et al, 2019). This paper reviews evidence on the effectiveness of these approaches and the implications of this research for current practice guidelines for women at low risk of postpartum haemorrhage who choose to birth in a midwife-led unit or home birth setting and want to experience a birth with minimal intervention.

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