An exploration of how midwives and physicians manage the third stage of labor in the United States.

INTRODUCTION

Care of the woman during the third stage of labor is a critical component of good patient outcomes. The type and extent of activities used in the United States, including those suggested for active management of the third stage of labor, are unknown. This study obtained preliminary data for the development of a national study of interventions used by US birth attendants during the third stage of labor, work that will ultimately lead to a study examining links between activities and outcomes. The specific aims were to identify provider-reported assessments and interventions used during the third stage of labor and to examine which management steps or interventions providers believe should always be used during the third stage of labor.

METHODS

Four provider-specific focus groups (certified nurse-midwives, certified professional midwives, obstetricians, and family practice physicians) were held using a nominal group technique. Two researchers analyzed audio-recorded transcriptions independently.

RESULTS

More than 100 assessments, 110 interventions, and 65 "always used" activities were identified. There was variation within and across groups. Midwife groups were more likely to specify maternal preference activities, and physician groups were more likely to specify drug-related actions.

DISCUSSION

Surveys of third-stage labor practices must include large numbers of actions to represent what may be the state of US practices. Survey design may need to include a multiple-forms approach to avoid participant burden. Designs should include the exploration of differences by provider type as well as within provider variation.