Management of third stage labour following vaginal birth in Iran: A survey of current policies

Objectivethis study was aimed to provide information on policies for the practice of managing the third stage of labour in Iran, including discussion of related systematic evidence.Designthis survey used a standard questionnaire to obtain information about prevention and early treatment of postpartum haemorrhage from all geographical areas in Iran, in 2010.Settingthe survey included maternity units from 23 provinces, covering 129 out of a total of 560 maternity units in Iran.Participantsat least one public hospital, one private hospital and one rural birth facility unit were included from each province. Questionnaires were completed by the unit's senior midwife with support from the unit's lead obstetrician.Findingsall the units who were approached responded to the study including 69 public hospitals, 32 private hospitals and 28 rural birth facility units. The rate of active management of the third stage of labour was 57 per cent, although answers to individual components of management indicated a higher rate for active interventions than expectant management. Ninety-four per cent of the responding centres indicated oxytocin administration, 71 per cent apply early cord clamping and 65 per cent apply controlled cord traction. A lack of standard definition for postpartum haemorrhage was reported in 18 per cent of units.Key conclusionsa high rate of active management was reported in Iran with variation in its different components which is in line with the international findings. These policies were mainly congruent with the existing systematic evidence except for timing of cord clamping.Implications for practicethere is a need for improvement in locally sensitive policy development, continuing education, establishing accurate auditing systems and ensuring access to facilities such as blood banks and products in rural units. Efforts to reduce maternal mortality and morbidity and investigations into their causes should be extended to factors beyond the third stage of labour care clinical components.