Postpartum Hemorrhage and Active Management of the Third Stage of Labor

PPH is the leading direct cause of maternal death. Two-thirds of women who experience PPH have no identifiable risk factors. SBAs should actively manage the third stage of labor to help prevent PPH.  Active management of the third stage of labor (AMSTL) includes:

  1. Administration of a uterotonic soon after birth
  2. Delivery of the placenta by controlled cord traction
  3. Uterine massage

WHO still recommends that even if AMSTL is not practiced, a uterotonic be administered to the woman during the third stage of labor to prevent PPH. Studies in Indonesia, Nepal, and Afghanistan suggest that, for women who deliver at home without access to skilled care, education, instruction, and community-based distribution of misoprostol (to prevent bleeding) by well-trained and supervised CHWs may be an important strategy to reduce maternal morbidity and mortality resulting from postpartum hemorrhage.[i] Oxytocin in Uniject™ is also a possibility. Programs should ensure that they work within national MOH policy guidelines on uterotonic use, including community-based distribution of misoprostol.

Key Resources for PPH Prevention and AMSTL:

Key Misoprostol-Specific Resources:


[i] MCHIP, 2011. Prevention of Postpartum Hemorrhage at Home Births. https://www.mchip.net/sites/default/files/PPH%20Prevention%20at%20Home%20Birth%20Briefer.pdf