The purpose of this study was to evaluate the effect of guided imagery on the third stage of labor. Blood loss from hemorrhage during childbirth, most commonly due to uterine atony, is one of the leading causes of maternal mortality in the United States and the leading cause of maternal death worldwide. The hypothesis was that the use of physiologic guided imagery would reduce the amount of bleeding during the third stage of labor.

Inclusion Criteria:

• 18 years of age or older but less than 35 years
• English as her primary language
• fetus in a cephalic presentation
• singleton pregnancy
• 36 to 38 estimated gestational weeks
• no contraindications to vaginal delivery
• maternal weight less than 200 pounds prior to pregnancy

Exclusion Criteria:

• more than four previous children
• a history of postpartum hemorrhage
• bleeding disorder
• seizure disorder
• polyhydramnios
• diabetes (including gestational)
• hypertension
• cardiac disease
• uterine fibroids
• anemia (hematocrit less than 30)
• intrauterine fetal demise or tobacco use