Knowledge, attitudes and practices of midwives towards active management of third stage of labour to preventing post partum heamohage: a case study in Mulago Hospital.

Abstract

ABSTRACT: Severe bleeding is the single most important cause of maternal deaths worldwide. Every year, over 500,000 women die as a result of childbirth. Of these, 25-60% die of postpartum haemorrhage (PPH). Unfortunately, the overwhelming majority of these deaths occur in developing countries like Uganda. Over 90% of women who die of PPH, 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 (AMTSL), effectively reduces the occurrence of PPH, caused by uterine atony by 60%. This study therefore explores knowledge, attitudes, practices and barriers to AMTSL by mid-wives of mulago hospital (Uganda). This study was a descriptive cross-sectional study design in which quantitative methods were used to collect data. 117 questionnaires and 50 checklists were administered to mid-wives who worked in the three labour wards of mulago hospital (L/S New Mulago, ward 14 upper mulago and ward 6D/E) within the study period of January to February. The findings revealed that, although mid-wives generally had good knowledge about AMTSL 70.9% stated the definition and 81.2% that AMSTL reduces blood, surprisingly their practices were very poor (26%) as regards AMTSL use. Attitudes towards AMSTL was positive, 66.7% stated that AMTSL should be used to all pregnant mothers. Practical aspects of non use of controlled cord traction(26%), use of maternal effort during placenta deliveries (74%) and non use of pitocin (26%) while 8% never used any uterotonics to conduct third stage of labour, demonstrated direct association with very poor practices of midwives as regards AMTSL. In view of the above results AMTSL is extremely poorly practiced (26%) by midwives of mulago hospital and a task force need to be installed to encourage and emphasize AMTSL practice plus support supervision.