Investigating active versus expectant management of third stage labour in a midwife-led unit
Little is known regarding third stage management approaches and the incidence of and treatment of postpartum haemorrhage in women giving birth solely in midwife-led units. This systematic literature review identified nine studies of varying quality that investigated active versus expectant management of the third stage of labour and any related blood loss in women, who had a normal physiological birth and gave birth or intended to give birth in a midwife-led unit. The results identified a need for further research studies into this area of practice, as birth settings are becoming increasingly more important. This is because of research studies that have reported many beneficial outcomes for healthy women at low risk of obstetric complications, who plan to give birth in midwife-led units.
It has been suggested that research studies informing third stage of labour practice guidelines and recommendations are questionable, particularly for women at low risk of postpartum haemorrhage who choose to birth in midwife-led units or home birth settings (Baker et al, 2021). This article discusses the findings from a literature review conducted in June 2021 and updated in August 2021, to answer the question of whether there are any published studies that have investigated active verse expectant management of the third stage of labour, and any related blood loss during this period or shortly after, in women who had a normal physiological birth and gave birth or intended to give birth in a midwife-led unit.
Active third stage of labour management approach in this study refers to acceleration of the delivery of the placenta to reduce blood loss using a prophylactic uterotonic drug (exogenous oxytocin) to accelerate the contractility of the uterus, causing the placenta to separate from the uterus wall more quickly. Other components of active management in this study may also include delayed or immediate cord clamping and controlled cord traction (National Institute for Health and Care Excellence (NICE), 2017; Royal College of Obstetricians and Gynaecologists (RCOG), 2016).
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