The purpose of this study was to evaluate the effect of guided imagery on the third stage of labor. Blood loss from hemorrhage during childbirth, most commonly due to uterine atony, is one of the leading causes of maternal mortality in the United States and the leading cause of maternal death worldwide. The hypothesis was that the use of physiologic guided imagery would reduce the amount of bleeding during the third stage of labor.
A 3-group randomized trial was conducted with women recruited between 36 to 38 weeks of pregnancy. The experimental group received a relaxation focused guided imagery intervention to use through the remainder of pregnancy plus a physiologic guided imagery intervention during the third stage of labor. The placebo group received the same relaxation focused guided imagery intervention but no guided imagery during the third stage of labor. A third group did not receive any guided imagery. Complete data were collected on 41 participants. Intrauterine activity was measured through the use of intrauterine pressure catheters. Comparisons of the length of third stage of labor and blood loss among the three groups were conducted using analysis of variance (ANOVA). No significant decrease in the length of third stage of labor or measured blood loss was found in the group that used guided imagery in the third stage compared with the other groups.
An overview was provided of new mothers' reflections on the use of guided imagery during the third stage of labor through the use of 38 semi-structured interviews conducted 24 to 48 hours postpartum. Experiences during the third stage of labor included maternal conflict between the desire to focus on the baby and ongoing discomfort and distractions. A variable level of pain was experienced during the third stage.
The use of guided imagery may decrease the need for invasive procedures and provide an additional tool in the armamentarium to minimize maternal morbidity during the third stage of labor while allowing the birthing woman to be a participative partner in care and self-healing. Additional study of this intervention during the third stage is warranted.
Keywords. Childbirth, Blood Loss, Guided Imagery, Hemorrhage, Third stage of labor.
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