{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T19:52:46Z","timestamp":1774381966016,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,1,29]],"date-time":"2017-01-29T00:00:00Z","timestamp":1485648000000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The prevalence of postpartum hemorrhage has increased in the United States despite the international promotion of active management of the third stage of labor. Adherence to the international recommendations in the United States is unclear. It is also not known how the components of active management are related to other practices that may be used during the third stage of labor. The purpose of this study was to determine routine practice patterns for managing the third stage of labor in the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A randomized national survey was conducted of certified nurse\u2010midwives\/certified midwives, certified professional midwives, obstetricians, and family physicians who self\u2010reported third\u2010stage practices. Descriptive analyses and partial correlations were used to determine differences in practice patterns between midwives and physicians. A 2\u2010step clustering algorithm was used to identify clusters of third\u2010stage practices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1243 clinicians responded. Uterine massage after placenta expulsion was reportedly used at almost every birth by all provider types. Median use of cord traction and oxytocin administration by all provider types was 80% and 90% of births, respectively. Cluster analysis of these and other interventions used during the third stage of labor revealed 4 distinct clusters of practices ranging from primarily a hands\u2010off at one extreme to high\u2010intervention approaches at the other extreme. The other 2 clusters were defined by practices that fell between those extremes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Determination of how, and under what conditions, clinicians decide when to use particular techniques to manage the third stage of labor and how these techniques influence the incidence of postpartum hemorrhage, is necessary. The clusters of practice combinations that emerged in this study suggest that there are extreme variations in clinician practices during management of the third stage of labor.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jmwh.12586","type":"journal-article","created":{"date-parts":[[2017,1,29]],"date-time":"2017-01-29T07:47:00Z","timestamp":1485676020000},"page":"58-67","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["US Physician and Midwife Adherence to Active Management of the Third Stage of Labor International Recommendations"],"prefix":"10.1111","volume":"62","author":[{"given":"Mavis N.","family":"Schorn","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary S.","family":"Dietrich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beth","family":"Donaghey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann F.","family":"Minnick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,1,29]]},"reference":[{"issue":"353","key":"e_1_2_8_2_1","first-page":"e1","article-title":"Trends in postpartum hemorrhage: United States, 1994\u20102006","volume":"202","author":"Callaghan WM","year":"2010","journal-title":"Am J Obstet Gynecol"},{"issue":"449","key":"e_1_2_8_3_1","article-title":"Incidence, risk factors, and temporal trends in severe postpartum hemorrhage","volume":"209","author":"Kramer MS","year":"2013","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007412.pub4"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5514.622"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.297.6659.1295"},{"key":"e_1_2_8_7_1","first-page":"76","article-title":"International Federation of Gynaecologists and Obstetricians (FIGO). 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