Practice And Factors Associated With Active Management Of Third Stage Of Labour (AMTSL) Among Care Providers In Regional Hospital Limbe.

Active management of the third stage of labor is recommended for the prevention of postpartum hemorrhage and commonly entails prophylactic administration of a uterotonic agent, controlled cord traction, and uterine massage. While oxytocin is the first-choice uterotonic, there is also insufficient evidence regarding the value of controlled cord traction or uterine massage. Active management of third stage of labor plays a great role to prevent childbirth related hemorrhage. Health care providers (HCPs) knowledge and skills are both crucial in saving the lives of mothers and their newborns during childbirth. However, maternal morbidity and mortality related to hemorrhage is high due to lack of knowledge and skill of obstetric care providers ‘on active management of third stage of labor. Post-partum hemorrhage (PPH) is the major cause of maternal mortality in Cameroon and worldwide. Our study was aimed to assess practice and factors associated with obstetric care providers (Midwives, Nurses, and Health officers) on active management of third stage of labor Regional Hospital Limbe, South West Region
Cameroon. Twelve in-depth interviews were conducted with labor ward midwives, care
providers who all had previous training in AMTSL. The study was conducted from August
2021 – August 5th 2022, at three hospitals in South West Region, Limbe and data was
analyzed using qualitative latent content analysis. Our main finding was that the third step of AMTSL, uterine massage, was not implemented, even though the general attitude
towards AMTSL was positive. Thus, despite regular training sessions, the midwives did not
follow the Cameroon national guidelines. Some contributing factors to difficulties in
providing AMTSL to all women have been pointed out in this study, the most important
being insufficiency in staff coverage. This led to a need for delegating certain steps of
AMTSL to other health care staff, i.e. task shifting. The knowledge and practice of obstetric
care providers towards active management of third stage of labor can be improved with
appropriate interventions like inservice trainings. This study also clearly showed that the
level of knowledge and practice of obstetric care providers to wards active management of third stage of labor needs immediate attention of Universities and health science colleges better to revise their obstetrics course contents, health institutions and zonal health bureau should arrange trainings for their obstetrics care providers to enhance skill.