Active Versus Expectant Management of Third Stage of Labor: A Plane of Nursing Action

Abstract

Background: Expectant management of the third stage of labor is known as conservative or physiological or passive management. Active management of the third stage of labor as a prophylactic intervention is composed of a package of three components: Administration of a uterotonic agent within one minute after the baby is born; after the cord is clamped; delivery of the placenta by controlled cord traction with counter-traction on the fundus; and fundal massage after delivery of the placenta. Aim: to compare the effects of active management versus expectant management of the third stage of labor and evaluate the effect of an educational programs on nurses' knowledge about the management of the third stage of labor. Subjects and methods:-Research-designs: Two research designs were used: The first is a cross-sectional descriptive survey. The second is a quasi-experimental intervention study. Sample: A total of 300 pregnant women; group (1) 150 women using active management compared with group (2) 150 ones using expectant management were randomly recruited for this study. As well as 20 nurses. Setting: The current study was conducted at the delivery unit in Beni-Suef University Hospital. Tools: Four tools were used, namely the interview questionnaire form, maternal assessment record, partograph, and nurses' knowledge questionnaire (preand post-test). Results:The results revealed that all women in the two groups had vaginal deliveries; the third stage was shorter in the active group, but the difference was not statistically significant. Women in the active group had significantly less blood loss at the second and third stages. The active group had significantly lower hemoglobin levels before delivery, but after delivery, this difference disappeared. Conclusion: Active management of the third stage of labor is associated with a shorter duration of the third stage, less blood loss, and less decline in the hemoglobin level. Post-intervention, there was a significant improvement in the nurse's knowledge about management of the third stage of labor. Recommendations: Active management of the third stage is a safe and effective procedure that should be used in the health care setting providing delivery care services.