A review of third stage of labour care guidance

Introduction Concerns exist regarding the suitability of national and international guidance informing third stage of labour care for women at low risk of postpartum haemorrhage. Methods The robustness and appropriateness of the research evidence underpinning third stage of labour care guidance by institutions such as the National Institution for Health and Care Excellence, the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives was assessed and areas for further research to address any gaps in knowledge were identified. Results National and international third stage of labour practice guidance recommend active management for all women. This may not be suitable for women at low risk of postpartum haemorrhage giving birth in a midwife-led unit or a home birth setting. This is because of the reduced reliability, validity and generalisability of the evidence informing this guidance to this group of women. Conclusions Expectant management may be more appropriate for women at low risk of postpartum haemorrhage who choose to birth in a midwife-led unit or home birth setting and want to experience a birth with minimal intervention. However, more research into third stage management practices in these settings is needed.