How Do Physicians and Midwives Manage the Third Stage of Labor? |
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| Authors: | Weiping M. Tan MD PhD CCFP Michael C. Klein MD FAAP FCFP ABFP Lee Saxell RM MA Sahba Eftekhary Shirkoohy MD MPH MHA Getnet Asrat MD MHSc |
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| Affiliation: | 1. 1Weiping M. Tan is in private practice as a Family Physician, Coquitlam, British Columbia;2. 2Michael C. Klein is a Professor Emeritus in the Department of Family Practice and Department of Pediatrics , 3Sahba Eftekhary Shirkoohy is a a PhD candidate at the University of Toronto;3. 4Getnet Asrat is a second year family practice resident at the University of Ottawa;4. and 5Lee Saxell is a Head in the Department of Midwifery, Children’s & Women’s Health Centre and Providence Health Care, Vancouver, British Columbia, Canada. Tan, Shirkoohy and Asrat were with University of British Columbia at the time of the study. |
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| Abstract: | ![]()
ABSTRACT: Background: Current practice guidelines recommend active management of the third stage of labor. We compared practices of three maternity care provider disciplines in management of third‐stage labor and the justifications for their approach. Methods: This study is a cross‐sectional survey of maternity practitioners in usual practice settings in British Columbia. All 199 obstetricians, all 82 midwives, and a random sample of family physicians practicing intrapartum maternity care (one‐third, or 346) were surveyed The three main outcome measures by discipline were the method preferred in managing third‐stage labor, the reasons given for the chosen method, and views on the appropriateness of the current third‐stage labor guideline. Results: The overall response rate was 57.8 percent. Response rates indicating that the participants were “aware of guideline” were the following: obstetricians, 85.3 percent; family physicians, 53.7 percent; and midwives, 97.8 percent. Response rates indicating that the participants “agreed with guideline” were the following: obstetricians, 95.2 percent; family physicians, 97.6 percent; and midwives, 51.2 percent. Response rates indicating that “oxytocin should be given with anterior shoulder” were the following: obstetricians, 71.1 percent; family physicians, 68.3 percent; and midwives, 26.7 percent. Response rates indicating that “routine active management of third stage of labor should be the norm” were the following: obstetricians, 79.2 percent; family physicians, 60.2 percent; and midwives, 17 percent. All results were statistically significant (p < 0.01). Conclusions: A major difference was found between physicians and midwives in the management of third‐stage labor. Physicians routinely implemented active management of the third stage of labor; midwives preferred expectant approaches, principally based on women’s preference. Provincial data did not show differences in postpartum hemorrhage or transfusion rates by practitioner type. (BIRTH 35:3 September 2008) |
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| Keywords: | third stage of labor active management expectant management clinical practice guidelines external and internal validity midwifery |
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