title: Pronurturance Plus at birth: A risk reduction strategy for preventing postpartum haemorrhage.
abstract: BACKGROUND
  Postpartum haemorrhage (PPH) rates continue to rise in the developed world. A recent study found that any skin-to-skin contact and breastfeeding within 30min of birth was associated with an almost 50% reduction in PPH rates. Improved oxytocin release is the biological reason proposed to explain this. The combination of skin-to-skin contact and breastfeeding within 30min of birth is termed 'Pronurturance'. Midwifery theory and research claims that optimal third stage care is more holistic than simple Pronurturnace which suggests that further reductions in PPH rates may be possible.
  
  
  OBJECTIVE
  What can midwives and women do to minimise blood loss in the third and fourth stages of labour?
  
  
  METHODS
  We present a new theory that describes and explains how to optimise the woman's reproductive psychophysiology in the third and fourth stages of labour to ensure a well contracted uterus which inhibits excessive bleeding regardless of risk status or whether active management was used. In developing the Pronurturance Plus theory we expand upon what is already known about oxytocin in relation to simple pronurturance to integrate concepts from birth territory theory, cognitive neuroscience, mindfulness psychology and the autonomic nervous system to develop an holistic understanding of how to optimise care and minimise PPH.
  
  
  CONCLUSIONS
  Pronurturance Plus is a psycho-biologically grounded theory which is consistent with existing evidence. It is free, natural and socially desirable.
authors.affiliation: Southern Cross University, School of Health and Human Sciences, Southern Cross Drive, Bilinga, Queensland 4225, Australia. Electronic address: Dfars1@pacific.net.au.
authors.forename: A
authors.initials: A
authors.lastname: Saxton
authors.affiliation: Gold Coast Campus, Southern Cross Drive, Bilinga, Queensland 4225, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Fahy
authors.affiliation: School of Health and Human Sciences, Southern Cross University, Locked Bag 4, Coolangatta, Queensland 4225, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Hastie
mesh_terms: D001942:Breast Feeding; D005260:Female; D006801:Humans; D007749:Labor Stage, Third; D008880:Midwifery; D010121:Oxytocin / Q000378:metabolism*; D036801:Parturition / Q000502:physiology*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D040242:Risk Reduction Behavior
chemical_list: D010121:Oxytocin
keywords: Cognitive neuroscience; Mindfulness psychology; Postpartum haemorrhage; Theory; Third stage of labour