Third Stage of Labour Management Approaches in Midwife-led Units

Practices during the third stage of labour are likely to be influenced by a range of factors, not just findings from studies. Also, little is known regarding the incidence of and treatment for postpartum haemorrhage (PPH) in women giving birth solely in midwife-led units or what factors midwives feel influence their use of third stage management approaches in this birth setting. Therefore, a research project (using a multi-method research design) exploring third stage of labour management approaches and incidents of PPH, as well as the acceptability and practicability of third stage approaches for women, giving birth in midwife-led units was conducted. This consisted of a quantitative and qualitative study.

Findings from the studies revealed a statistically significant increase in the incidence of PPH (defined as blood loss 500 mL or over) with expectant compared to active management. There was also a statistically non-significant incidence in the relationship between third stage management approaches and incidence of severe PPH (defined as blood loss of more than 1000 mL). Also, although more women who initially received expectant management needed treatment for excessive bleeding, once these women received this first-line treatment their need for further treatment, to manage continual bleeding was slightly reduced. This is compared to women who initially received active management and experienced a PPH.

Additionally, from interviews with midwives four themes were developed capturing midwives’ understanding of the factors they felt influenced their use of third stage management approaches in midwife-led units. It was evident that tensions were present within and between these themes and midwives need to balance these tensions when trying to provide woman-centred care. The themes generated from these interviews need to be addressed to facilitate third stage of labour management approaches. This is because this research project, with support from other studies, found that expectant management was a reasonable option for women at low risk of PPH, who wanted to labour and birth with minimal intervention in a midwife-led unit.