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Afterpains: A Comparison Between Active and Expectant Management of the Third Stage of Labor
Author(s) -
Jangsten Elisabeth,
Bergh Ingrid,
Mattsson LarsÅke,
Hellström AnnaLena,
Berg Marie
Publication year - 2011
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/j.1523-536x.2011.00487.x
Subject(s) - medicine , childbirth , obstetrics , cephalic presentation , labor pain , third stage , oxytocin , expectant management , vaginal delivery , randomized controlled trial , population , cervix , gestational age , visual analogue scale , pregnancy , gynecology , gestation , anesthesia , surgery , training (meteorology) , genetics , physics , environmental health , cancer , meteorology , biology
Background: Management of the third stage of labor, the period following the birth of the infant until delivery of the placenta, is crucial. Active management using synthetic oxytocin has been advocated to decrease blood loss. It has been suggested, but not studied, that oxytocin may increase afterpains. The aim of this study was to compare women’s experience of pain intensity when the third stage of labor was managed actively and expectantly and their experience of afterpains. Methods: A single‐blind, randomized, controlled trial was performed at two delivery units in Sweden in a population of healthy women with normal, singleton pregnancies, gestational age of 34 to 43 weeks, cephalic presentation, and expected vaginal delivery. Women ( n = 1,802) were randomly allocated to either active management or expectant management of the third stage of labor. Afterpains were assessed by Visual Analog Scale (VAS) and the Pain‐o‐Meter (POM‐WDS) 2 hours after delivery of the placenta and the day after childbirth. Results: At 2 hours after childbirth, women in the actively managed group had lower VAS pain scores than expectantly managed women ( p = 0.014). Afterpains were scored as more intense the day after, compared with 2 hours after, childbirth in both groups. Multiparas scored more intense afterpains, compared with primiparas, irrespective of management ( p < 0.001). Conclusions: Active management of the third stage of labor does not provoke more intense afterpains than expectant management. (BIRTH 38:4 December 2011)