Canterbury DHB


Labour and postnatal care including management of massive obstetric haemorrhage

Where a competent patient 18 years or older has made a clear and unequivocal advance decision to refuse consent to blood products and other interventions, during labour or the postnatal period, this is an advance directive and on the face of it the patient's wishes must be followed, unless there are reasonable grounds for believing the advance directive is not valid in the circumstances, or that the patient has changed her mind. Health practitioners treating such patients should be aware that it is quite possible that a patient may change her mind at any time, including at the last minute and/or in an emergency phase of treatment. If the circumstances envisaged in the advance directive do not apply or the patient changes her mind, the advance directive will be invalid and should not be followed.

The patient's advance directive must be clearly documented in the clinical notes and all staff who may be involved in the patient's care should be informed.

A hospital delivery is recommended and the on-call obstetric and anaesthetic team contacted at the earliest opportunity once it is known that a JW patient, or any other patient who has refused blood products and associated interventions, is coming in to hospital. Active management of the third stage of labour has been associated with a twofold reduction in risk of postpartum haemorrhage (PPH) [19]. Oxytocics should be administered and the woman closely observed.

Please refer to hospital guidelines for management of PPH.

The patient should be encouraged to report any bleeding after delivery and after leaving hospital.

About this Canterbury DHB document (47852):

Document Owner:

Julia Czuprynska and Richard Seigne (see Who's Who)

Last Reviewed:

June 2019

Next Review:

June 2022


Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 47852