title: Factors contributing to postpartum blood-loss in low-risk mothers through expectant management in Japanese birth centres.
abstract: OBJECTIVE
  To describe aspects of expectant midwifery care for low-risk women conducted in midwifery-managed birth centres during the first two critical hours after delivery and to compare differences between midwifery care, client factors and postpartum blood loss volume.
  
  
  METHODS
  As a secondary analysis from a larger study, this descriptive retrospective study examined data from birth records of 4051 women who birthed from 2001 to 2006 at nine (21%) of the 43 midwifery centres in Tokyo. Nonparametric and parametric analyses identified factors related to increased blood loss. Interviews to establish sequence of midwifery care were conducted.
  
  
  RESULTS
  The midwifery centres provided care based on expectant management principles from birth to after expulsion of the placenta. Approximately 63.3% of women were within the normal limits of blood loss volume under 500g. A minority of women (12.9%) experienced blood loss between 500 and 800g and 4% had blood loss exceeding 1000g. Blood loss volume tended to increase with infant birth weight and duration of delivery. The total blood loss volume was significantly higher for primiparas than for multiparas during the critical two hours after delivery and for immediately after delivery, yet blood loss volume was significantly higher for multiparas than for primiparas during the first hour after delivery. Preventive uterine massage and umbilical cord clamping after placenta expulsion resulted in statistically significant less blood loss. Identified were two patterns of midwifery care based on expectant management principles from birth to after expulsion of the placenta. The practice of expectant management was not a significant factor for increased postpartum blood loss.
  
  
  CONCLUSIONS
  These results detail specific midwifery practices and highlight the clinical significance of expectant management with low risk pregnant women experiencing a normal delivery.
authors.affiliation: Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamotomachi, Nagasaki 852-8520, Japan. Electronic address: heto@nagasaki-u.ac.jp.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Eto
authors.affiliation: Gifu University, School of Medicine, Nursing Course, 1-1 Yanagito, Gifu 501-1194, Japan. Electronic address: a_hase@gifu-u.ac.jp.
authors.forename: Ayako
authors.initials: A
authors.lastname: Hasegawa
authors.affiliation: St. Luke's International University, College of Nursing, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan. Electronic address: yaeko-kataoka@slcn.ac.jp.
authors.forename: Yaeko
authors.initials: Y
authors.lastname: Kataoka
authors.affiliation: St. Luke's International University, College of Nursing, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan. Electronic address: seporterslcn@hotmail.com.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Porter
mesh_terms: D000328:Adult; D016550:Birthing Centers; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007564:Japan; D008880:Midwifery / Q000379:methods*; D006473:Postpartum Hemorrhage / Q000451:nursing* / Q000517:prevention & control*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Birth homes; Expectant management; Midwives; Post-partum blood loss; Postpartum haemorrhage