PURPOSE:
Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality globally, despite the availability of clinical guidelines. The third stage of labour is a crucial window for PPH prevention, and nurse-midwives play a pivotal role in its management. In Portugal, inconsistencies in clinical decision-making and implementation of best practices persist. This project aims to explore the factors that influence nurse-midwives' decision-making during the third stage of labour, through the lens of woman-centred care and evidence-based practice.

DISCUSSION:
This mixed-methods study will be conducted in three phases. Phase I consists of a scoping review to map existing international evidence on clinical decision-making during the third stage of labour. Phase II involves a qualitative study using semi-structured interviews to explore Portuguese nurse-midwives’ experiences and perceptions, analysed through the lens of the Midwifery Model of Women-Centred Childbirth Care (MiMo), which emphasises relational care, professional autonomy, and the broader birthing context. Phase III will involve the adaptation and validation to the Portuguese context of international instruments to assess knowledge, attitudes, practices, and perceived barriers to evidence-based care, followed by a cross-sectional study using the validated tools. Together, these phases will offer a comprehensive understanding of clinical decision-making in this critical stage.

EVIDENCE WHERE RELEVANT:
Evidence shows that decisions during the third stage of labour are shaped by contextual factors such as institutional norms, midwives’ experiential knowledge, and interprofessional dynamics. The MiMo framework offers a valuable lens to interpret how woman-centred values influence these decisions. The Portuguese context remains underexplored in this regard.

KEY MESSAGE:
Understanding the factors that influence nurse-midwives’ decision-making in third stage labour management is essential for aligning practice with evidence-based and woman-centred care. This study seeks to provide meaningful insights to inform future strategies that promote safer, more consistent midwifery care in Portugal. Labour and birth - PPH (including three-minute presentation competition)