Abstract

Active management of the third stage of labor (AMTSL) is a key intervention aimed at reducing postpartum hemorrhage, a leading cause of maternal mortality. This study assesses the implementation of AMTSL practices among midwives and nurses at the Buea Regional Hospital, evaluating adherence to protocols and the subsequent impact on postpartum health outcomes. The study employs a cross-sectional observational method, combining structured interviews with healthcare providers, checklist-based observations of AMTSL practices during deliveries, and a review of postpartum patient records.

Data were gathered over a six-month period, with a focus on three main components of AMTSL: administration of a uterotonic drug immediately after delivery, controlled cord traction, and uterine massage. Findings indicate that while 85% of midwives and nurses consistently administer a uterotonic drug, only 60% adhere strictly to the full AMTSL protocol. Gaps were particularly noted in the timing and technique of controlled cord traction and uterine massage, both critical for minimizing hemorrhage risk. Contributing factors include inadequate staffing during peak delivery times, sporadic availability of essential medications, and a lack of standardized refresher training on AMTSL procedures.

The impact of incomplete AMTSL implementation on postpartum health was evident in the observed postpartum hemorrhage rates, with higher instances of hemorrhage among cases where AMTSL protocols were partially followed. Moreover, patients under full AMTSL management showed faster recovery and fewer complications, underscoring the procedure’s importance in reducing maternal morbidity. The study also highlights the role of continuous training in building skills and adherence to protocols, with 40% of providers expressing a need for more frequent AMTSL-focused workshops.

Recommendations include the establishment of regular AMTSL training sessions for midwives and nurses, consistent supply of uterotonic drugs, and the development of a checklist to ensure full adherence to AMTSL steps. Additionally, policies should focus on adjusting staffing patterns to meet delivery demands, thereby ensuring that AMTSL practices can be fully implemented during every delivery. Improved adherence to AMTSL protocols can significantly enhance maternal outcomes, reduce postpartum complications, and align healthcare practices with global maternal health standards.

Keywords: Active management of third stage labor (AMTSL), postpartum hemorrhage, midwives, nurses, Buea Regional Hospital, maternal health, protocol adherence, Cameroon.