Assessment of Practising Midwives on the Management of the Third Stage of Labour

Abstract

The third stage of labour is the separation and expulsion of the placenta and membranes following the birth of a baby. The management of this stage can directly influence postpartum haemorrhage (PPH), which is one of the world’s leading causes of maternal mortality. This study investigates adherence to the active management of the third stage of labour (AMTSL) using the protocol of the International Confederation of Midwives (ICM) and the International Federation of Gynaecology and Obstetrics (FIGO) by practising midwives, and identifies major barriers to its use. A quantitative research design was used. All 50 midwives working in the labour wards of a hospital and a health centre in Accra, Ghana, were recruited for the study. Data collection tools comprised a checklist on AMTSL and a questionnaire for assessment of the knowledge and perception of midwives. One hundred and fifty facility-based deliveries were observed and the midwives were rated using a checklist, with each of the 50 midwives observed three times. Data were analysed using the Statistical Package for the Social Sciences (SPSS). The findings indicate that the majority (40; 80%) of the midwives stated that they practised AMTSL while the remainder (10; 20%) stated that they used both active and expectant management. Further research demonstrated that the majority (36; 72%) administered oxytocin within 1 minute after the delivery of the baby which conforms to the ICM/FIGO protocol. Additionally, more than half (26; 52%) of the midwives said the best time to deliver the placenta by controlled cord traction (CCT) is when the contraction of the uterus is felt by the midwife. The overall mean skill performance was 45.7 ± 3.1 suggesting that the midwives’ performance was average on the ICM/FIGO protocol for AMTSL on a five-point Likert Scale. With respect to barriers to the correct use of AMTSL, the midwives cited various reasons including shortage and inadequate training of staff, improper storage of oxytocic drugs, lack of knowledge and skill on AMTSL, and decisions to adhere to other methods of managing the third stage of labour. The findings of this study have implications for midwives in managing the third stage of labour.