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Systematic Review: The Clinical Effectiveness of Physiological (Expectant) Management of the Third Stage of Labor Following a Physiological Labor and Birth

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BACKGROUND: The aim of this review was to establish the clinical effectiveness of physiological third-stage care following a physiological labor and birth.

METHODS: Seven databases and 9 journals were searched over a 25-year period resulting in the review of 38 papers. Of these, 34 papers were excluded because they included women who had received intervention during labor or birth; only 4 papers met the inclusion criteria. A research protocol and quality assessment were guided by the Centre for Reviews and Dissemination (CRD, 2008) and the meta-analysis of observational studies in epidemiology (MOOSE) guidelines for observational studies (Stroup et al., 2000). Studies were included if they described outcomes of care for women who had a physiological labor and birth and received expectant (physiological) care during the third stage of labor.

RESULTS: Two randomized controlled trials (RCTs) and 2 observational studies involving well, healthy women in high-income countries provided outcome information on a total of 35,455 participants and their third-stage outcomes. Results found little difference in mean blood loss between expectant third-stage care and active management (range 200–361 ml), no difference in maternal hemoglobin postnatal (when reported), and no increase in postpartum hemorrhage (PPH) when physiological care was provided.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A physiological third stage of labor can be supported for women when there has been a physiological labor and birth, and the woman is well and healthy.
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Document Type: Research Article

Publication date: 2011-09-01

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  • The International Journal of Childbirth is a peer-reviewed, quarterly journal publishing original research, reviews, and case studies concerned with the practice of midwifery, women's health, prenatal care, and the birth process. The journal encourages the exploration of the complex and contextual issues surrounding childbirth provision and outcomes and invites manuscripts from a wide range of clinical, theoretical, political, methodological, psychological, public health, policy, and multicultural and interdisciplinary perspectives.
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