Assessment Of Knowledge, Attitude, And Practice Of Midwives On Active Management Of Third Stage Of Labour At Selected Health Centers Of Addis Ababa, Ethiopia, 2014

Rahel Yaekob Tsehay Shimelis, Tsehay Shimelis Tafesse Lamaro


Background: The third stage of labour which, starts immediately after the infant is born, includes the separation and detachment of the placenta from the uterine wall, and ends with complete expulsion of the placenta and membrane. This period is considered to be the most hazardous stage for the birthing woman due to the risk of profuse hemorrhage. Severe bleeding is the single most important cause of maternal deaths worldwide. Over 90% of women who die of postpartum hemorrhage, the most important cause is uterine atony, however, research shows that a simple, inexpensive, effective, adaptable and evidence based practical technique known as active management of third stage of labour  effectively reduces the occurrence of hemorrhage caused by uterine atony by 60%.

Objective: The objective of this study was to assess the Knowledge, Attitude, and Practice of Midwifes on active management of third stage of labour at selected health centers of Addis Ababa.

Methods: Institution based cross sectional study supplemented with observation was conducted among Midwives in health center of Addis Ababa. Convenience sampling method was carried out. The questionnaires contain open as well as closed ended questions which covers socio demographic information, knowledge, attitude and practice of midwives on active management of third stage of labour. These were prepared in English. After checking for completeness and consistency, data was coded and entered into Epi-info programs and transported to SPSS version 17 for analysis Data was presented by tables.

Result: 136 midwives who worked in the 26 health center of Addis Ababa were included in the study. The findings revealed that, although mid-wives generally had good knowledge about active management of third stage of labour 82.4% stated the definition, about, 69(50.7%) of midwives stated that active management of third stage of labour preventing PPH and about, 35 (25.7%) of them responded that it is increases the ability of uterus to contract, and facilitate separation of placenta. Attitudes towards active management of third stage of labour was positive, 133 (97.8%) stated that active management of third stage of labour should be used and advantageous to all pregnant mothers to prevent postpartum hemorrhage. Practical aspects regards active management of third stage of labour, 106 (77.9%) had given oxytocin with in the first minute, 121(89%) used  controlled cord traction, 117 (86%) performed uterine massage with in the first minute after delivery and only 92 (67.6%) had estimated blood loss. When considering that standard observation guide and standard questions set on active management of third stage of labour, only 70 (51.5%) of midwives achieved satisfactory standard scores in knowledge question and 64 (47%) had achieved good in skills.

Conclusion: Midwives should be trained to update the knowledge and skill in order to provide safe and qualified care. Not only training but also supportive supervision should integrate as necessary to achieve the goals set for maternal and newborn survival.


Key words: Oxytocin, active management, Third stage of labor, Postpartum Haemorrhage.

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