Selkirk Medical Group
Information for Parents -to-be
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Active Management of Third Stage of Labour
The third stage of labour is the time between when the baby is born and when the
mother has stabilized after the placenta is delivered. The delivery of the placenta
happens with contractions of the uterus which shear the placenta off the wall of the
uterus. Then the placenta is delivered by the mother's pushing efforts aided by
guidance from the doctor or midwife.
What is Active Management of the Third Stage?
Active Management consists of giving the mother a shot of oxytocin in the thigh while the baby is being
born. Oxytocin is the same hormone that the body produces to contract the uterus and reduce blood loss.
Along with the contraction that follows the administration of oxytocin the doctor or midwife guides the
delivery of the placenta, usually aided by the mother's pushing effort. The cord may be cut by a family
member or the doctor or midwife after the cord has stopped pulsating.
What are the Benefits of Active Management of the Third Stage?
Excessive bleeding and hemorrhage are among the most common complications of childbirth.
Research consistently shows that active management reduces blood loss by approximately one third and
reduces the number of hemorrhages by up to 70%. It is estimated that for every 12 women who receive
Active Management, one serious postpartum hemorrhage is prevented.
Active Management is especially important if there are risk factors for having a hemorrhage including
previous postpartum hemorrhage or retained placenta, a long exhausting labour, a very fast (precipitous)
labour, large baby, or contractions spacing or weakening. Active Management is also important if the
consequences from a hemorrhage might be increased because the mother has low hemoglobin or low
platelets.
Are There Risks to Active Management of the Third Stage?
Some women are concerned about the pain of the needle in the thigh. The feedback we receive is that
most women do not feel the shot since it is given as the baby is emerging. Others worry that the synthetic
oxytocin might impact the woman's own production of oxytocin. This is unlikely since oxytocin is very fast
acting and goes through the system quickly. We also know that the synthetic oxytocin does not cross the
blood brain barrier and would not be able to affect brain signals for natural
oxytocin production.
Are there special circumstances to be aware of?
Postpartum hemorrhage can occur without warning and in the absence of
any obvious risk factors. It can be life threatening for the mother and disturbs
the bonding time between mother and baby after the birth. Certainly, if a
hemorrhage is occurring, we will need to use oxytocin and possibly other
medications to help stop the bleeding. This may need to be done
immediately without taking the time to discuss the pros and cons in the midst
of a criti cal emergency. Our goal is a safe outcome for mother and baby.
15