Effect of third stage of labour management approaches on the incidence of post-partum haemorrhage in women birthing at midwife-led units

Background National/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 (PPH) with active management compared to expectant management. The association in midwife-led units for low-risk women is relatively untested. Aims To examine the relationship between third stage of labour management approaches, and incidence of PPH (blood loss 500-1000mL) and severe PPH (blood loss >1000mL), in women birthing in midwife-led units. Methods Anonymised data was collected in 2015-16 from women birthing in England. Associations were assessed using adjusted logistic regression. Findings 59/765 women intending to receive active management and 71/508 intending to receive expectant management, experienced PPH (p=0.015). 14/765 women intending to receive active management and 16/508 intending to receive expectant management experienced severe PPH (p=0.134). Conclusions PPH, but not severe PPH, is higher in women birthing in midwife-led units intending to receive expectant management.