Comparison of Policies for the Management of Care for Women and Newborns During the Third Stage of Labor Among Japanese Hospitals, Clinics, and Midwifery Birth Centers

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To determine the care policies for both mothers and newborns implemented during and after the third stage of labor and to compare the rate of adoption of these care policies among hospitals, clinics, and midwifery birth centers in Japan.


A cross-sectional survey of the care policies affecting mothers and newborns during and after the third stage of labor was conducted from October 2010 to July 2011. A postal questionnaire with follow-up was sent to all 684 maternity institutions in Tokyo metropolitan areas.


The overall response rate was 255 (37%). Most hospitals and clinics had a policy of early cord clamping; however, nearly 70% of the midwifery birth centers adopted the policy of waiting until the cord stopped pulsating. The policy of administering prophylactic uterotonics was adopted by 50% of the hospitals and 63% of the clinics, although midwifery birth centers did not adopt this policy. All midwifery birth centers, 50% of the hospitals, and 50% of the clinics routinely adopted the policy of early skin-to-skin contact.


Adoption of various care policies differed considerably among the hospitals, clinics, and midwifery birth centers. In addition, there were several gaps between evidence-based care and care policies.

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