Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Active Management of the 3rd Stage of Labour

Active management of the third stage reduces postpartum haemorrhage through a uterotonic, appropriate cord management, and controlled cord traction by a skilled provider. It must follow current national policy and clinical assessment.

Purpose

  • Reduce postpartum haemorrhage
  • Promote safe placental delivery
  • Detect retained placenta, uterine atony, and genital-tract trauma early

Indications

  • After birth of the baby when the third stage is being managed actively
  • Increased haemorrhage risk or maternal preference after informed discussion
  • Retained placenta or bleeding requiring escalation

Equipment

  • Prescribed uterotonic and administration equipment
  • Cord clamp and sterile scissors
  • Gloves, pads, receiver, and waste receptacle
  • Vital-sign equipment
  • Placenta examination tray and documentation materials

Preparation

  • Confirm uterotonic, resuscitation, examination, and referral equipment before birth.
  • Explain the plan to the woman.

Procedure steps

  • Confirm a second baby is not present and assess maternal condition and bleeding.
  • Administer the recommended uterotonic promptly after birth according to policy and contraindications.
  • Use appropriate cord-clamping timing and clamp or cut safely.
  • Observe for signs of placental separation and perform controlled cord traction only with a contracted uterus and counter-pressure.
  • Receive the placenta and membranes, inspect completeness, and assess uterine tone and blood loss.
  • Massage or assess the uterus as indicated and monitor vital signs.
  • Escalate retained placenta, excessive bleeding, uterine inversion, shock, or incomplete placenta immediately.
  • Continue maternal and newborn skin-to-skin and breastfeeding support when stable.
  • Dispose of materials and maintain infection prevention.
  • Document medication, times, cord care, placenta, blood loss, observations, interventions, and response.

Precautions

  • Never pull on the cord without uterine contraction and counter-traction.
  • Do not delay emergency treatment for placenta inspection.
  • Check uterotonic contraindications and correct dose and route.
  • Treat heavy bleeding, shock, or uterine inversion as emergencies.

Aftercare

  • Monitor uterine tone, blood loss, vital signs, bladder, and comfort.
  • Support early breastfeeding and continue postpartum haemorrhage surveillance.

Nursing considerations

  • Use accurate blood-loss estimation and active communication.
  • Examine the placenta systematically and report missing cotyledons or membranes.

Patient education

  • Explain uterotonic effects, uterine assessment, and why ongoing monitoring is needed.
  • Tell the woman to report increased bleeding, dizziness, or severe pain.

Documentation

  • Record uterotonic name, dose, route, time, cord management, placenta and membranes, blood loss, observations, and response.
  • Document escalation and handover.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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