Originally Posted by AmieV
Well, color me shocked and ignorant because I had no clue that A guide to Effective Care in pregnancy and childbirth advocated active management of third stage labor, stating that it creates a 70% reduction in PPhemorrhage, and that the WHO endorses this as well.
Does someone want to explain this to me as well as point me in the directionof research that proves the contrary? Because this seems completely counterintuitive and backwards to me and it's weird because the WHO and AGTECIPAC have historically backed up my opinions not refuted them!
Sorry if non-pro's aren't allowed in here....
: I'm just intensely interested in the topic. It may not be entirely accurate to say that the WHO backs it 100%; rather, it backs it with some notable caveats.
I found a 1997 statement from the WHO, although I'm not sure if it's based on obsolete data: http://www.who.int/reproductive-heal...apter5.en.html
"In conclusion, oxytocin administration immediately after delivery of the anterior shoulder, or after delivery of the infant, seems advantageous, especially in women with increased risk of postpartum haemorrhage or in women endangered by even a small amount of blood loss, for instance women with severe anaemia. Doubts remain about the combination with controlled cord traction, and about the routine application in healthy low-risk women. Recommendation of such a policy would imply that the benefits of this management would offset and even exceed the risks, including potentially rare but serious risks that might become manifest in the future. In our opinion it is too early to recommend this form of active management of the third stage for all normal low-risk deliveries, although we note the earlier recommendations made by WHO (1990, 1994c). If for various reasons active management is employed, a number of questions remain unresolved, particularly regarding the optimal timing of prophylactic oxytocin injections."
And there's some ambiguity on the cord clamping issue:
"If controlled cord traction after oxytocin administration is practised, as is the case in many obstetric departments worldwide, early or relatively early clamping of the cord is mandatory. However, where late clamping is taught and practised, i.e. after the pulsations of the cord have ceased, usually after about 3-4 minutes, adverse effects have not been recorded. In addition, recent research supports late clamping, because it may prevent iron deficiency anaemia in childhood, which might be of special importance in developing countries (Michaelsen et al 1995, Pisacane 1996). Although at present there is insufficient evidence on which to decide between early and late clamping, this issue clearly deserves more attention."