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Card 4After making sure there are no more babies, give oxytocin within one minute after birth of baby tomake the uterus contract.• If there is another baby, wait for the birth of the last baby before applying AMTSL.• If there is not another baby, FIRST tell the mother that you would like to give her a medication that will help the placenta come outand prevent bleeding. Ask her if you can go ahead.• Begin AMTSL (delivery of the placenta) by giving the woman 10 IU of oxytocin IM in the upper thigh within one minute after birth ofthe last baby. If the facility does not have oxytocin, give ergometrine 0.2 mg IM, or Syntometrine 1 mL IM, or misoprostol 600 mcgorally.Remember that oxytocin is the drug of choice for active management of the third stage of labor!!• If available, a qualified assistant should give the injection while you care for the woman and baby.• This should be done within one minute of childbirth.• You should only give an injection if you have been trained and are allowed to do it.QUESTIONS1) How does oxytocin help the placenta come out?2) Why is it important to give the injection within 1 minute after the last baby is born?KEY MESSAGES• Oxytocin is a medicine that helps the uterus to contract (become hard). When the uterus becomes hard, this helps the placentaseparate from the wall of the uterus and then come out. Because the uterus is contracted, there is also less bleeding.• Oxytocin takes 2-3 minutes to stimulate the uterus to contract, so you need to give it as soon as possible after the baby is born.
After making sure there are no more babies, give oxytocin within one minute afterbirth of baby to make the uterus contract.Card 4
Page 1: Managing the third stage oflabor in
Page 6: How to Use the FlipchartYou can use
Page 9 and 10: Prepare for active management of th
Page 11 and 12: Prepare for active management of th
Page 13 and 14: Dry the baby, put her on her mother
Page 15: See if there is another baby.Card 3
Page 19 and 20: Give misoprostol (if oxytocin is no
Page 21 and 22: Never give misoprostol or oxytocin
Page 23 and 24: Clamp and cut the cord after cord p
Page 25 and 26: Put the baby on the mother’s ches
Page 27 and 28: Wait for a uterine contraction.Card
Page 29 and 30: Do controlled cord traction while s
Page 31 and 32: Gently deliver the placenta.Card 11
Page 33 and 34: Massage the woman’s uterus.Card 1
Page 35 and 36: Teach the woman how to massage her
Page 37 and 38: Carefully examine the placenta.Card
Page 39 and 40: Carefully examine the woman’s ext
Page 41 and 42: Facilitate breastfeeding, if this i
Page 43 and 44: Carefully monitor the woman after c
Page 45 and 46: Carefully monitor the baby.Republic
Page 47 and 48: Recognize and teach danger signs in
Page 49 and 50: Recognize and teach danger signs in
Page 51: Recognize and teach danger signs in

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