Active Management of Third Stage of Labor: Practice and Associated Factors among Obstetric Care Providers in North Wollo, Amhara Region, Ethiopia

Abstract

Background. World Health Organization strongly recommends that every obstetrical provider at birth needs to have knowledge and skills on active management of the third stage of labor and use it routinely for all women. However, implementation of this lifesaver intervention by skilled birth attendants is questionable because 3% to 16.5% of women still experience postpartum hemorrhage. Even though coverage of giving births at health facilities in Ethiopia increases, postpartum hemorrhage accounts for 12.2% of all maternal deaths occurring in the country. Lack of the necessary skills of birth attendants is a major contributor to these adverse birth outcomes. Objectives. This study aimed to assess the active management of the third stage of labor practice and associated factors among obstetric care providers. Methods. An institution-based cross-sectional study design was applied from March 15 to April 15, 2020. Multistage sampling techniques were used to get 254 participants, and data were collected using self-administered structured questionnaires and an observation checklist. Data were entered into EpiData version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 23.0 for analyses. The multivariable logistic regression model was used at 95% confidence interval with P value <0.05. Among the 232 providers participating in the study, only 75 (32.3%) of respondents had a good practice. The practice of the provider was significantly associated with work experience (adjusted odd ratio 0.206 (95% confidence interval, 0.06–0.63)), knowledge (adjusted odd ratio (2.98 (95% confidence interval, 1.45–6.14)), the presence of assistance (adjusted odd ratio 2.04 (95% confidence interval, 1.06–3.93)), and time of uterotonic drug preparation (adjusted odd ratio 4.69 (95% confidence interval, 2.31–9.53)). Conclusion. Only one-third of obstetric care providers had good practice during active management of third stage of labor. Practice was significantly associated with work experience, knowledge, the presence of assistance during third-stage management, and time of uterotonic drug preparation. Consistent and sustainable on job training and clinical audit should be applied in all facilities with regular supportive supervision and monitoring. Furthermore, team work and adequate preparation should be done to facilitate the management of active third stage of labor.

Active management of the third stage of labor and associated factors among maternity care providers in public health facilities in Eastern Ethiopia: a multi-center study

“…This implies that 60% of laboring mothers might face life-threatening complications like severe hemorrhage and its related complications. This finding is consistent with previous studies in Ethiopia (Tigray 43.3%) and Nigeria (41.7%), but higher than studies in Sudan (26.7%), and Ethiopia such as in Kembata Tembaro zone (29.8%), Amhara region (32.3%), Sidama zone (32.8%) and Hawassa city (15.7%) [ 26 – 28 , 38 , 40 – 42 ]. The disparity could be attributed to the study period, educational level, and training.…”

“…Presence of birth assistants in addition to MCPs increased the likelihood of good practice of AMTSL. This is in harmony with studies in Ethiopia and Nigeria [ 28 , 38 ]. The presence of assistants is one of the critical factors in performing good AMTSL and this is true in all maternity procedures where only team efforts will provide adequate care.…”

“…A community-based cross-sectional study in Bale, Ethiopia revealed that only 29.2% were assisted by skilled birth attendants [ 25 ]. Other studies in Ethiopia revealed rates of AMTSL ranging from 16.7% to 32.3% [ 26 – 28 ]. Such low rates lead to many lost opportunities to prevent PPH [ 29 ].…”

Effect of High Fidelity Simulation on Intern Students' Competency regarding Clinical Guidelines for Active Management of the Third Stage of Labor

“…2 (Suppl) , May 2022 reported that 10% of all maternal deaths were prevented with timely, effective and full use of clinical guidelines for active management of third stage of labor. This reduces the incidence of postpartum hemorrhage, the need for blood transfusion, and the use of therapeutic utero tonics during the third stage of labor, improving women's health and reducing maternal mortality that is central to the 2030 agenda for sustainable development strategy (9,10) .…”