Third stage of labour management approaches and postpartum haemorrhage in midwife-led units

Background National and international guidelines advise active management of the third stage of labour. Studies conducted in obstetric-led units reveal evidence for reductions in primary postpartum haemorrhage with active management compared to expectant management. The association in midwife-led units for low-risk women is relatively untested in the UK. Aims To examine the relationship between third stage of labour management approaches, and incidence of postpartum haemorrhage and severe postpartum haemorrhage in women birthing in midwife-led units. Methods Anonymised data were collected in 2015–2016 from women birthing in England. Adjusted logistic regression was used to assess the effect of management approach on the outcomes of postpartum haemorrhage and severe postpartum haemorrhage, controlling for variables additionally identified as risk factors for postpartum haemorrhage. Results Of the 765 women intending to receive active management and the 508 intending to receive expectant management, 9.54% and 14.0% experienced postpartum haemorrhage respectively (P=0.015). Severe postpartum haemorrhage was experienced by 14 (1.83%) women intending to receive active management and 16 (3.66%) intending to receive expectant management (P=0.134). Conclusions Postpartum haemorrhage, but not severe postpartum haemorrhage, was statistically significantly higher in women birthing in midwife-led units intending to receive expectant management.