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Changing practice with evidence--'active management of the third stage of labour': the Nursing & Midwifery Community for Making Pregnancy Safer, part of the Global Alliance for Nursing & Midwifery, held a virtual global discussion on AMTSL.

The Nursing and Midwifery Community for Making Pregnancy Safer and the Parteria y Enfermeria para una Maternidad Segura Community sponsored a virtual global discussion forum on changing practice with evidence, 30 September-10 October, 2008. The purpose was to promote dialogue and exchange ideas on how to change practice, using research-based evidence, in active management of the third stage of labour (AMTSL). The virtual discussion was held in English and Spanish with facilitators who maintained the common themes in the two communities.

Experts for the English language community discussion were:

* Debra Armbruster, Senior Program Officer, PATH

* Bremen De Mucio, Latin American Center for Perinatology, PAHO

* Jose Luis Diaz-Rossello, Latin American Center for Perinatology, PAHO

* Kathy Herschderfer, Independent Consultant

* Lisa Kane-Low, Assistant Professor, University of Michigan

* Matthews Mathai, Department of Making Pregnancy Safer, WHO, Geneva

Experts for the Spanish language community were:

* Bremen De Mucio, Latin American Center for Perinatology, PAHO

* Jose Luis Diaz-Rossello, Latin American Center for Perinatology, PAHO

* Gloria Metcalfe, Independent Consultant

The first days of the discussion covered general comments from the experts about the importance of the topic. Participants shares successes and barriers to changing practice specific to management of the third stage of labour.

Themes and issues

Common themes and issues in the discussions included:

1. Some individual providers have adopted AMTSL or adapted it to their practice realities even though it has not yet been made the standard of care in the institution. Adaptations have blended the evidence with experience and wisdom. There were also expressions of disagreement with or questions about the evidence for AMTSL. Questions were raised regarding congruence of active management with movements for humanisation of birth and/or a midwifery model of care which emphasise minimal intervention. It was suggested that, according to the guideline, the mother would be given the choice of having AMTSL or not.

2. It was emphasised that implementing evidence-based practice must also take into consideration the needs and wants of the patient/woman, for example, identifying culturally sensitive ways to implement AMTSL when a woman desires an upright birthing position.

3. Questions were raised regarding the implications (explicit or implicit) of current scopes of practice for individuals attending deliveries, those considered 'skilled' and others who attend deliveries but are not included in the category of 'skilled'. These comments were also related to how much of the intervention the provider is permitted to carry out alone, with supervision and/or as part of a team.

4. There were relatively few examples of experiences that led to successful uniform implementation of AMTSL as the standard of care in an institution or system. Some of the issues raised were:

* training provided without necessary supervised practice to mastery

* inadequate policy and standards work with stakeholders

* standards had not been agreed to and disseminated

* not having the necessary supplies available at all times.

Documents, materials and websites

Technical documents, reports and websites for additional information:

English and Spanish:

* Joint Statement on Preventing Post Partum Hemorrhage. ICM/FIGO 2006.

* Tita TN et al. Evidence-based reproductive health care in Cameroon: population-based study of awareness, use and barriers. WHO Bulletin 2004; 83:205 abstract.

* Preventing Postpartum Hemorrhage: Managing the Third Stage of Labor. Outlook 2002; 19 (3).

* Reproductive Health Library (A number of studies and reviews of the evidence for AMTSL)

English only:

* WHO Managing postpartum haemorrhage (Midwifery education module 2)

* WHO Prevention of postpartum haemorrhage by AMTSL (MPS technical update)

* WHO recommendations for the prevention of postpartum haemorrhage

* WHO/RHR on Translating Research into Programs (TRIP)

Spanish only:

* Lista de Verificacion de Destrezas Clinicas MATEP

* MATEP ayuda de trabajo

* OPS_Practicas de Atencion del Parto updated feb 08

* POPPHI resumen one pager-Spanish

* POPPHI_Herramientas para proveedores_MANUAL.
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Title Annotation:active management of the third stage of labour
Publication:International Midwifery
Geographic Code:1USA
Date:Dec 1, 2008
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