Knowledge And Competency Of Midwives In Implementation Of Active Management Of Third Stage Of Labour In Meru County, Kenya

ABSTRACT 

Active Management of the Third Stage of Labor (AMTSL) is an evidence-based, low-cost intervention focusing prevention of postpartum hemorrhage (PPH) which accounts for over 25% globally and Kenya at 33.9% translating to 510 deaths /100,000 live births. The study aimed at assessing knowledge and competencies of midwives in active management of third stage of labor in health facilities of Meru County. The study adopted a descriptive cross sectional design and utilized stratified random sampling to categorize the health facilities and participants were randomly selected. The target population was 375 midwives from the selected facilities out of which a sample population of 125 midwives were selected. Primary data was collected using questionnaires, interview guide and observational checklist. Data collected was edited, coded and analysed using the Statistical Package for Social Sciences (SPSS) version (20.0) after which the findings were presented using data tables, bar graphs and pie charts. Percentages, and chi-square, correlation, regression, factor analysis were used in data analysis.The researcher got permit from National Commission for Science and Technology (NACOSTI) and clearance from Kenyatta University Research Ethics Committee (KUERC). The researcher also sought authority from the hospital management board and informed consent was sought from the respondents before issuing of the questionnaires. From the study, 87 Registered Nurse-midwives, 19 Enrolled Nursemidwives and 19 degree holder’s respondents filled-in and returned the questionnaires making a response rate of 100%. The study showed that midwife demographic characteristics are a major determinant of the outcomes of active management of third stage of labor. Majority 33(26.4%) of the respondents fell into the ages of 26-30 years. The minority 13(10.4%) of the respondents were between 18-25 years old. Majority 87(69.6%) of the respondents were registered nurse-midwives. In addition, 19(15.2%) of respondents were enrolled nurse-midwives while the 19(15.2%) of the respondents were degree holders midwives. All 125(100.0%) of the respondents knew the AMTSL standards document. The level of knowledge of midwives on active management of third stage of labor in selected health facilities of Meru County was inadequate as 17(13.6%) didn’t have the idea on factors that promote AMSTL administration. A section of the respondents were in agreement that the AMTSL standards application should take between 5 and 10 minutes, massaging of the uterus within the first 2 hours at an interval of 15 minutes. There was association between whether respondents were aware of AMTSL and where they got expertise on AMTSL, since the source of AMTSL and knowledge was statistically significant at 95% confidence interval (χ² =22.24, DF=1, P=0.001). Most (46.4%)of the midwives used the AMTSL wall charts as their reference during the AMTSL standards application and most (86.4%) of the midwives stated that they do keep the AMTSL standards to counter postpartum hemorrhage. Understaffing was regarded by majority (40.8%) of the midwives as a challenge in keeping the AMTSL standards during their practice. Finally, the study concluded that competence of the midwives in active management of third stage of labor was an issue since some (49.6%) midwives took more than one minute in oxytocin administration which is against International federation of gynecology and obstetrics (ICM/FIGO) definition. It was also seen that IM Oxytocin was used by majority (96.8%) of nurses and 67.2% administered 10 I.U as recommended on AMTSL standards. The null hypothesis was accepted in that midwives with high level of knowledge and competence performed well in AMTSL than those who did not have.