The effect of early nipple stimulation on third stage of labour duration and estimated blood loss: A systematic review and meta-analysis.

Background: Post-partum haemorrhage due to uterine atony remains a leading cause of maternal mortality worldwide with a high portion occurring in under resourced settings. The risk of post-partum haemorrhage increases with prolonged duration of the third stage of labour. Early nipple stimulation promotes the early release of oxytocin, which has beneficial effects on uterine tone. Therefore, this meta-analysis evaluates the impact of early nipple stimulation on the duration of the third stage of labour and estimated blood loss.

Aim: To assess whether early nipple stimulation following uncomplicated deliveries effects the duration of the third stage of labour and estimated blood loss.

Methods: A comprehensive search was conducted in PubMed, EMBASE, Cochrane, CiNAHL, Scopus and Web of Science, covering studies published up to February 5 2024. Eligible studies included randomised control trials and observational studies involving women with singleton pregnancies and live foetuses who engaged in nipple stimulation in the third stage. Studies that reported the duration of the third stage of labour and/or estimated blood loss were included. Exclusion criteria comprised stillbirths, multiple pregnancies and the use of general anaesthesia. Data was analysed using a random-effects model. This review was registered with PROSPERO (CRD42023494605).

Results: Nine studies involving 789 mothers were included. Early nipple stimulation reduced blood loss and improved uterine tone. When synthetic oxytocin was not used, early nipple stimulation reduced the duration of the third stage of labour.

Conclusion: Early nipple stimulation may be a viable alternative to uterotonics in uncomplicated deliveries, especially in low-resource settings. Further high-quality primary research is indicated to build upon the preliminary findings of this current meta-analysis.