An additional issue of debate related to the
administration of prophylactic uterotonics is the ideal
timing of this intervention. It has been variously
suggested that oxytocin be given after the anterior
shoulder, after the birth of the baby or after delivery of
the placenta. Other midwifery and obstetrical
guidelines argue for delivery after the anterior shoulder,
and within one minute of delivery of the baby
respectively.14,27 Earlier work47 which proclaimed that use of oxytocics at the time of birth confers a decreased
chance of hemorrhage when compared to giving
oxytocics after the placenta has been contradicted. A
recent RCT that compared giving oxytocin before versus
after placental delivery found no difference in the
incidence of PPH or the length of third stage.48 Given
the lack of clarity in the research and limited evidence
on which to base recommendations, prophylactic
oxytocin can be given after the birth of the anterior
shoulder, or after the delivery of the baby up to and
including within one minute of delivery of the baby