A typology for categorising management of the third stage of labour

A typology for categorising management of the third stage of labour

Tina IreneHarris De Montfort University, Leicester, United Kingdom

Background: Variation in the practice of midwives during the third stage of labour is well recognised (Begley 2015) and categorising third stage management into Active Management (AM) and Expectant Management (EM) has been challenged (Harris 2005). Creating a typology for practice may help midwives to record more accurately the care given to women, and to allow further comparative studies to reflect the nuances of practice.

Purpose/Objective: A comparison of published descriptions of third stage management was undertaken to assess the similarities and differences between them and to identify whether these descriptions could be categorised into types of third stage practice.

Method: 49 practice descriptions were sourced from 31 publications which included research articles, review papers and textbooks. Each description was extracted from the text and tabulated according to each individual component of management (n=11) identified within the descriptions. This allowed comparisons to be made between them.

Key Findings: Between 1 and 4 descriptions of third stage management were identified from each source reviewed. Significant differences between management descriptions were revealed. Six types of third stage management were identified, based upon the level of midwife activity during the third stage and whether a uterotonic drug was administered. These are: ‘Limited Active Management’, ‘Partial Active Management’, ‘Complete Active Management’, ‘Limited Expectant management’, ‘Partial Expectant Management’ and ‘Complete Expectant Management’.

Discussion: The changing evidence base around third stage management approaches (Begley 2015), requires midwives to record more clearly the nuances of their practice. The typology created here may provide a framework for midwives to use in practice to record the third stage care delivered and provide a means to compare approaches to identify what elements of third stage management are of benefit in reducing blood loss in women and do no harm to their babies. References: Begley, C., Gyte, G.M.L., Devane, D., McGuire, W., Weeks, A., (2015 Active versus expectant management for women in the third stage of labour (Review) The Cochrane Library, Issue 3. Accessed 29/01/15 @ http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007412.pub4/pdf/standard

Harris(2005) Midwifery practice in the third stage of labour. PhD thesis. Leicester : De Montfort University.