Pronurturance Plus … great food for thought

2857946166_f53e6e4bd6As a long-time fan of physiological, unmedicated placental birth (where appropriate, of course), I’m always happy to see papers which explore the value of this and the ways in which we can facilitate women’s and babies’ health and well-being at this time. So I was excited to spot a recent article in Women and Birth called Pronurturance Plus at birth: A risk reduction strategy for preventing postpartum haemorrhage.

I think I might know what some of you are thinking, though!

What’s pronurturance?

And when I tell you that the authors define pronurturance as the combination of skin-to-skin cuddling and breastfeeding, and that ‘pronurturance plus’ is the integration of this with elements of a theory about midwifery guardianship, I know that some people will ask why it needs a fancy name, or to be woven into a new theory, when many of us have known about and practised this for many years.

Well, as much as it annoys me that our culture is so focused on risk reduction by means of well-defined interventions, it makes sense to me that one way of responding to this is to create our own language and theories showing how paying attention to physiological processes is actually just as beneficial – and sometimes more so – than intervening with drugs and procedures. It does, to coin a phrase, naff me off that our culture seems so ignorant and disrespectful of the precautionary principle, but I have long said that we need to create more woman-centred, midwifery model based, positive language, so I want to be near the front of the applause when others do just that. This paper is full of food for thought, and will be a great reference point for those who want to base their work in physiology without having to justifying it themselves every time. It does describe a theory rather than a research study, and theories are meant to be debated, so I’m going to ponder it further, and I’m looking forward to finding out what others think.  I really enjoyed reading it, and I hope you will too.


The Research:

Background: Postpartum haemorrhage (PPH) rates continue to rise in the developed world. A recent study found that any skin-to-skin contact and breastfeeding within 30 min of birth was associated with an almost 50% reduction in PPH rates. Improved oxytocin release is the biological reason proposed to explain this. The combination of skin-to-skin contact and breastfeeding within 30 min of birth is termed ‘Pronurturance’. Midwifery theory and research claims that optimal third stage care is more holistic than simple Pronurturnace which suggests that further reductions in PPH rates may be possible.

Question: What can midwives and women do to minimise blood loss in the third and fourth stages of labour?

Method: We present a new theory that describes and explains how to optimise the woman’s reproductive psychophysiology in the third and fourth stages of labour to ensure a well contracted uterus which inhibits excessive bleeding regardless of risk status or whether active management was used. In developing the Pronurturance Plus theory we expand upon what is already known about oxytocin in relation to simple pronurturance to integrate concepts from birth territory theory, cognitive neuroscience, mindfulness psychology and the autonomic nervous system to develop an holistic understanding of how to optimise care and minimise PPH.

Conclusion: Pronurturance Plus is a psycho-biologically grounded theory which is consistent with existing evidence. It is free, natural and socially desirable.


Saxton A, Fahy K, Hastie C (2015). Pronurturance Plus at birth: A risk reduction strategy for preventing postpartum haemorrhage. Women and Birth, in publication.  doi:10.1016/j.wombi.2015.11.007


If you’d like to stay up-to-date, check out my workshops, where we look at the latest studies and discuss how they can help us in practice…

photo credit: Cologne Autumn via photopin (license)

5 comments for “Pronurturance Plus … great food for thought

  1. January 12, 2016 at 12:09 am

    Dear Sara,

    Thank you for your wonderful review of our paper. Anne, Carolyn and I have been involved in researching and theorising about midwifery and postpartum haemorrhage for about 10 years now and have a number of related publications. Carolyn’s practice as an independent home birth midwife has been crucial for understanding the ‘how to’ of being a midwife in the 3rd and 4th stages of labour. The careful review of physiology that Anne did for her PhD on this topic tied together theory and practice. We have also published statistical evidence of effectiveness. I agree with you Sara that as midwives we need to engage in the discussion in the mainstream and a paper like this makes a good contribution.

  2. January 12, 2016 at 12:10 am

    Oh, one more thing, people can get a free copy of this paper from my Research Gate site.


    • January 13, 2016 at 11:59 am

      Oh great, thank you so much for sharing, Kathleen. I wondered about adding a list of your other related publications in the blog post, but the list on Research Gate will stay up to date, so it’s probably better if people go there. I’m so glad that you’re all doing this research, thank you 🙂 x

      • January 15, 2016 at 2:37 am

        Thanks, yes I put all of my pre-publication versions of my papers on Research Gate where people can access easily for free.

        YOu are doing great work yourself, spreading the good word about woman-centred care and all its benefits for the woman and her baby.

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