Active Management of Third Stage of Labor | Baby Doulas

The active management of the third stage of labor (AMTSL) is a critical component of obstetric care that involves a series of steps to reduce postpartum hemorrhage risk, including uterotonic administration, controlled cord traction, and uterine massage. According to the World Health Organization (WHO), AMTSL is recommended for all vaginal births, with a uterotonic injection given within one minute of birth. However, controversy surrounds the routine use of uterotonics, with some arguing it may increase the risk of hypertonic uterine contractions and fetal distress. A study published in The Lancet in 2015 found that AMTSL reduced the risk of postpartum hemorrhage by 65%, with a number needed to treat of 14. Despite this, a 2020 Cochrane review highlighted the need for further research on the optimal uterotonic regimen. The American College of Obstetricians and Gynecologists (ACOG) recommends AMTSL for all vaginal births, with a uterotonic injection given within one minute of birth. With a vibe score of 8, this topic has significant cultural energy, particularly among obstetricians, midwives, and expectant mothers, with influence flows from key organizations such as the WHO and ACOG, and entity relationships between uterotonics, postpartum hemorrhage, and maternal mortality.