 This is the VOA Special English Health Report. Severe bleeding, also called hemorrhage, causes one-third of pregnancy-related deaths in Asia and Africa. The World Health Organization has been recommending several ways to reduce the risk of hemorrhage immediately after birth. These include giving the mother a hormone called oxytocin. It helps the uterus expel the placenta or afterbirth. Another recommendation to help expel the placenta has been to use what is called controlled cord traction. In this procedure, the birth attendant gently pulls on the umbilical cord while pushing upwards on the mother's stomach. Dr. Metin Gulmezolo of the World Health Organization led a study on the effectiveness of controlled cord traction. He says it is not easy to perform, and if it is not done by people who are skilled in doing it, then it can harm the mother. The study involved more than 23,000 pregnant women who had vaginal births. The births happened in 16 hospitals and two primary healthcare centers in eight countries. These were Argentina, Egypt, India, Kenya, the Philippines, South Africa, Thailand, and Uganda. About half of the mothers received a so-called full package of measures including controlled cord traction. The other women gave birth helped only by gravity and pushing by the mother. Both groups of women received injections of oxytocin immediately after giving birth. The study showed that on average both groups had about the same amount of blood loss. The study found that controlled cord traction had very little effect in reducing the risk of serious blood loss defined as a leader or more. There was serious blood loss in 1.9% of the women who received the procedure compared to 2.1% of those in the simplified group. Dr. Gulmezolo says using oxytocin was much more important than pulling on the umbilical cord to reduce blood loss. He says the main factor that helps to reduce blood loss after birth is the oxytocin, the medication that helps the uterus to contract. Oxytocin is injected but only into the muscle. This makes it easier to administer for birth attendance with little training. Also the hormone does not cost very much but it can lose its effectiveness if stored at high temperatures. The WHO may recommend single use syringes with sensors to warn of exposure to high temperature. The WHO is expected to change its guidelines based on the new findings. The study is in the Lancet Medical Journal. For VOA Special English, I'm Alex Villarreal.