09/09/2026
Yes 🫶🏻
https://bit.ly/4qXbnd3
This systematic review (a study of studies on a particular topic) compared routine oxytocin administration, the key component of “Active Management of Third Stage,” with expectant management and physiologic care to determine which policy best prevents postpartum hemorrhage. The investigators made these comparisons because the studies that established Active Management as superior had compared it with expectant management, i.e., doing nothing. They theorized that the proper comparison was to physiologic care, itself a package of protective measures, including “creating a warm, safe environment, encouraging upright positioning, and promoting immediate skin-to-skin contact with the newborn.”
The review included 7 studies and 7,091 participants. All participants were low risk and had labors that began and progressed on their own and ended in vaginal birth.
When routine oxytocin was compared with expectant management, expectant management resulted in 21 more cases per 1,000 of blood loss equal to or greater than 1,000 mL.
When routine oxytocin was compared with physiologic care, physiologic care resulted in 18 fewer cases per 1,000 of blood loss equal to or greater than 1,000 mL.
Two studies allowed them to make a comparison between routine oxytocin and expectant management in populations with limited or no use of epidurals and no instrumental vaginal deliveries. Expectant management resulted in 19 more cases per 1,000 of blood loss equal to or greater than 1,000 mL.
Physiologic care--which unlike active management has no adverse effects--is therefore much the superior option for preventing hemorrhage in low-risk, spontaneous labors ending in vaginal birth.
For more on the weaknesses of the studies of active vs. expectant management, see my article “Just Say “No” to Active Management of Third-Stage Labor.” https://hencigoer.com/just-say-no-to-active-management-of-third-stage-labor/
