Management of third stage labour following vaginal birth in Iran: A survey of current policies Poorandokht Afshari, MSc, BSc (Lecturer) a , Janet Medforth, MSc, BSc (Medforth (Midwifery Senior Lecturer)) b , Mohsen Aarabi, MD, MPH, PhD (Assistant Professor) c , Parvin Abedi, PhD, MSc, BSc (Assistant Professor) a , Hora Soltani, PhD, MMedSci, BSc, PGDip in Higher Education (Professor of Maternal and Infant Health) d, n a School of Nursing and Midwifery, Ahvaz Jundishapur University, Ahvaz, Iran b Faculty of Health and Wellbeing, 34 Collegiate Crescent, Sheffield Hallam University, Sheffield S10 2BP, UK c Golestan University, Iran d Health & Social Care Research Centre, 32 Collegiate Crescent, Sheffield Hallam University, Sheffield S10 2BP, UK article info Article history: Received 23 November 2012 Received in revised form 22 January 2013 Accepted 4 February 2013 Keywords: Third stage of labour Postpartum haemorrhage Survey Policy abstract Objective: this 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. Design: this survey used a standard questionnaire to obtain information about prevention and early treatment of postpartum haemorrhage from all geographical areas in Iran, in 2010. Setting: the survey included maternity units from 23 provinces, covering 129 out of a total of 560 maternity units in Iran. Participants: at 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. Findings: all 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 conclusions: a 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 practice: there 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. Crown Copyright & 2013 Published by Elsevier Ltd. All rights reserved. Introduction Postpartum haemorrhage is a major cause of maternal mor- tality across the world, mainly in developing countries (World Health Organisation, 2007). Although several other factors con- tribute to the mothers’ safety during birth such as maternal malnutrition and poor health, poverty and available facilities such as transfer, access to blood transfusion and intensive care, third stage of labour care is considered a crucial step in prevent- ing postpartum haemorrhage related mortality and morbidity (Lalonde et al., 2006). The two major care approaches for the third stage of labour include active management and expectant management. Accord- ing to the International Confederation of Midwives and Interna- tional Federation of Gynecology and Obstetrics (Lalonde et al., 2006), active management should be offered to all women, including administration of uterotonics, (delayed) cord clamping, controlled cord traction and uterine massage (Lalonde et al., 2006). Expectant management is commonly considered as no or Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter Crown Copyright & 2013 Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.midw.2013.02.002 n Corresponding author. E-mail addresses: p_afshary@yahoo.com (P. Afshari), J.A.Medforth@shu.ac.uk (J. Medforth), mohsen.aarabi@gmail.com (M. Aarabi), parvinabedi@ymail.com (P. Abedi), h.soltani@shu.ac.uk (H. Soltani). Please cite this article as: Afshari, P., et al., Management of third stage labour following vaginal birth in Iran: A survey of current policies. Midwifery (2013), http://dx.doi.org/10.1016/j.midw.2013.02.002i Midwifery ] (]]]]) ]]]–]]]