Competence of midwives in prevention and management of postpartum Haemorrhage at Kiambu District Hospital labour ward, Kiambu County

Abstract

Introduction: Post-partum haemorrhage (PPH) is a leading cause of maternal mortality worldwide and is responsible for 34% of maternal deaths in Africa. It is defined as blood loss of more than 500 ml following vaginal delivery or more than 1000 ml following caesarian delivery. Blood loss can occur during the first 24 hours (primary PPH) or from 24 hours up to 6 weeks after delivery (secondary PPH). Primary PPH classified by site is either placental or extraplacental bleeding. Secondary PPH is abnormal or excessive bleeding from the birth canal between 24 hours and 6 weeks postnatal. Objectives: To establish midwives competencies in prevention and management of PPH: the knowledge and skills the midwives possess in prevention and management of PPH. Study design: Descriptive study. Setting: The study was conducted at labour ward of Kiambu district hospital. Methods: After approval by UON/KNH ethics and research committee and permission from Kiambu District Hospital management, the principal investigator and one research assistant collected data by use of structured questionnaire and an observation checklist after obtaining consent from eligible participants. Data was stored in a password protected computer and a flash disc under the safe custody of the principal investigator. Data was analyzed by use of statistical package of social and scientists (SPSS) version 20.0. Study results: During the study period from July to August 2015, 22 midwives working at Kiambu district hospital labour ward filled the questionnaire and 18 of this were observed while conducting deliveries. All midwives were females, 90.9% were KRCHN, 59.1% had worked in a labour ward setting for 0-4 years and 68.2% were trained on active management of third stage of labour(AMSTL) which is key in prevention of PPH. Knowledge on components of AMSTL was 100% for administration of uterotonics, 95.5% for controlled cord traction and 86.4% for uterine massage.77.3% had knowledge that administration of uterotonic should be within a minute of delivery of the infant but on observed deliveries only 13.6% managed to administer within this time .Uterotonic supplies were always present and physiological management of third stage of labour was not practiced. Competence on AMSTL practice on observed deliveries was 44.4%. Conclusions: This study has yielded new knowledge on midwives knowledge and skills on prevention and management of PPH. Midwives had adequate knowledge on prevention of PPH (overall 90%) but need improvement in actual performance (skills) since majority of the mothers missed the preventive benefit associated with administration of prophylactic uterotonic within a minute of delivery of the infant. Recommendations: Ensuring that midwives get current updates through the continuous professional development programme and availing guidelines on active management of third stage of labour at the labour ward would go a long way in improving performance.