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How Do Physicians and Midwives Manage the Third Stage of Labor?

Authors

  • Weiping M. Tan MD, PhD, CCFP,

    1. 1Weiping M. Tan is in private practice as a Family Physician, Coquitlam, British Columbia; 2Michael C. Klein is a Professor Emeritus in the Department of Family Practice and Department of Pediatrics, 3Sahba Eftekhary Shirkoohy is a a PhD candidate at the University of Toronto; 4Getnet Asrat is a second year family practice resident at the University of Ottawa; and 5Lee Saxell is a Head in the Department of Midwifery, Children’s & Women’s Health Centre and Providence Health Care, Vancouver, British Columbia, Canada. Tan, Shirkoohy and Asrat were with University of British Columbia at the time of the study.
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  • 1 Michael C. Klein MD, FAAP, FCFP, ABFP,

    Corresponding author
    1. 1Weiping M. Tan is in private practice as a Family Physician, Coquitlam, British Columbia; 2Michael C. Klein is a Professor Emeritus in the Department of Family Practice and Department of Pediatrics, 3Sahba Eftekhary Shirkoohy is a a PhD candidate at the University of Toronto; 4Getnet Asrat is a second year family practice resident at the University of Ottawa; and 5Lee Saxell is a Head in the Department of Midwifery, Children’s & Women’s Health Centre and Providence Health Care, Vancouver, British Columbia, Canada. Tan, Shirkoohy and Asrat were with University of British Columbia at the time of the study.
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  • 2 Lee Saxell RM, MA,

    1. 1Weiping M. Tan is in private practice as a Family Physician, Coquitlam, British Columbia; 2Michael C. Klein is a Professor Emeritus in the Department of Family Practice and Department of Pediatrics, 3Sahba Eftekhary Shirkoohy is a a PhD candidate at the University of Toronto; 4Getnet Asrat is a second year family practice resident at the University of Ottawa; and 5Lee Saxell is a Head in the Department of Midwifery, Children’s & Women’s Health Centre and Providence Health Care, Vancouver, British Columbia, Canada. Tan, Shirkoohy and Asrat were with University of British Columbia at the time of the study.
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  • 5 Sahba Eftekhary Shirkoohy MD, MPH, MHA,

    1. 1Weiping M. Tan is in private practice as a Family Physician, Coquitlam, British Columbia; 2Michael C. Klein is a Professor Emeritus in the Department of Family Practice and Department of Pediatrics, 3Sahba Eftekhary Shirkoohy is a a PhD candidate at the University of Toronto; 4Getnet Asrat is a second year family practice resident at the University of Ottawa; and 5Lee Saxell is a Head in the Department of Midwifery, Children’s & Women’s Health Centre and Providence Health Care, Vancouver, British Columbia, Canada. Tan, Shirkoohy and Asrat were with University of British Columbia at the time of the study.
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  • and 3 Getnet Asrat MD, MHSc 4

    1. 1Weiping M. Tan is in private practice as a Family Physician, Coquitlam, British Columbia; 2Michael C. Klein is a Professor Emeritus in the Department of Family Practice and Department of Pediatrics, 3Sahba Eftekhary Shirkoohy is a a PhD candidate at the University of Toronto; 4Getnet Asrat is a second year family practice resident at the University of Ottawa; and 5Lee Saxell is a Head in the Department of Midwifery, Children’s & Women’s Health Centre and Providence Health Care, Vancouver, British Columbia, Canada. Tan, Shirkoohy and Asrat were with University of British Columbia at the time of the study.
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Michael C. Klein, MD, FAAP, FCFP, ABFP,L408, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada.

Abstract

ABSTRACT: Background: Current practice guidelines recommend active management of the third stage of labor. We compared practices of three maternity care provider disciplines in management of third-stage labor and the justifications for their approach. Methods: This study is a cross-sectional survey of maternity practitioners in usual practice settings in British Columbia. All 199 obstetricians, all 82 midwives, and a random sample of family physicians practicing intrapartum maternity care (one-third, or 346) were surveyed The three main outcome measures by discipline were the method preferred in managing third-stage labor, the reasons given for the chosen method, and views on the appropriateness of the current third-stage labor guideline. Results: The overall response rate was 57.8 percent. Response rates indicating that the participants were “aware of guideline” were the following: obstetricians, 85.3 percent; family physicians, 53.7 percent; and midwives, 97.8 percent. Response rates indicating that the participants “agreed with guideline” were the following: obstetricians, 95.2 percent; family physicians, 97.6 percent; and midwives, 51.2 percent. Response rates indicating that “oxytocin should be given with anterior shoulder” were the following: obstetricians, 71.1 percent; family physicians, 68.3 percent; and midwives, 26.7 percent. Response rates indicating that “routine active management of third stage of labor should be the norm” were the following: obstetricians, 79.2 percent; family physicians, 60.2 percent; and midwives, 17 percent. All results were statistically significant (p < 0.01). Conclusions: A major difference was found between physicians and midwives in the management of third-stage labor. Physicians routinely implemented active management of the third stage of labor; midwives preferred expectant approaches, principally based on women’s preference. Provincial data did not show differences in postpartum hemorrhage or transfusion rates by practitioner type. (BIRTH 35:3 September 2008)

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