Are low risk women receiving enough information from their midwives to enable them to make an informed choice regarding the third stage of labour?

Aim: The main aim of the study was to determine if women were receiving unbiased information from their midwives in the antenatal period about the choices available to them for care in the third stage of labour to enable them to make an informed choice.

Method: The method design was mainly quantitative in the form of a survey utilising a questionnaire in a single centre. Participants were women who had been identified as low risk for postpartum haemorrhage and who birthed their babies in the local, consultant led maternity unit between 10thDecember 2012 and 28th March 2013. The study received approval from the East of England, Cambridge South Research Ethics Committee, the respective National Health Service Research and Development department and The University of Nottingham as the sponsor of the study.

Results: The response rate was 23%. Sixty three percent (19/30) of the participants stated that they had received enough information from their community midwife to make an informed choice and 77% (23/30) had decided on how they would like to deliver their placenta prior to going to hospital in labour. Approximately two thirds of the participants stated that they had received information about the benefits and disadvantages of physiological care and active management. However the benefits of active management and disadvantages of physiological care were given a greater emphasis than the disadvantages of active management and the advantages of physiological care. Thirty percent (9/30) of participants sought information about the third stage of labour from other sources. Two thirds of the women (20/30) thought that having this choice was either important or very important.

Conclusions: The results from this study would suggest that the majority of women considered that they did receive enough information to make an informed choice during the antenatal period. However it is not possible to comment whether, the information received by women was sufficient or presented in an unbiased manner to make a truly informed choice, or was based upon current evidence rather than outdated hospital guidelines. Therefore it is recommended that further observational research is carried out to determine the information midwives are giving and whether all the benefits and disadvantages of physiological care and active management are being discussed in a truly unbiased manner. Recommendations for practice primarily concern midwives reflecting on and challenging the information that they are giving women and how this information is given. Are they truly offering informed choice? Are they providing information to women that is evidence based or from guidelines that are out of date? As current evidence suggests that physiological care for the third stage of labour is the safest method following a physiological labour and birth, should this become the default position in these cases? Finally, this raises the issue of whether choice or consent are required for a normal physiological process.