Midwives' Utilization of Life Saving Skills for Prevention and Management of Haemorrhage in Nigeria

Background:Annually, 36,000 women die in Nigeria as a result of complications of pregnancy and child birth, 70% of these deaths were due to four conditions. Obstetric hemorrhage is the most common cause, of which 99% occurs as primary postpartum haemorrhage (PPH). Predicting who will have primary postpartum haemorrhage based on risk factors is difficult because two-thirds of women who have PPH have no risk factor. Primary postpartum haemorrhage can be prevented and treated by early, aggressive, and coordinated interventions. Life Saving Skill (LSS) are set of actions that helps care giver prevent, recognize and manage life threatening emergencies. The Life Saving Skill measures for prevention and management of haemorrhage are active management of third stage of labour, manual removal of placenta, bimanual compression of the uterus and manual removal of clots and product of conception. LSS has been part of midwifery curriculum and in-service training in Nigeria.  This study assessed the midwives knowledge and practice of Life saving skills for the prevention and management of haemorrhage, and the factors influencing its practice. Three hypotheses were generated and tested with pearson correlation and chi-square at p value of 0.05.

Methods:This descriptive study utilized structured questionnaire and observation checklist for data collection. Questionnaire was given to 177 midwives working in 126 primary health centers in 15 purposively selected Local Governments Area. While 60 midwives who were among the 177 midwives were observed. Their knowledge was rated as follows: high knowledge (score of 70%); moderate knowledge (score of 50% - 69%) and poor knowledge (score of < 50%).  Extent of utilization was rated high with a score of > 50% and low with a score of  50%.

Results:About (52.5%) of the respondents were highly knowledgeable and (37.3%) have moderate knowledge. For their practice, 70.6% of the respondents stated that they highly practice it but on observation, only (21.7%) highly practice it. Majority practice some components of the procedures like clamped and cut the cord (95%) and uterine massage (73.3%). Also all the respondents gave oxytocin but only (13.3%) gave it on delivery of the anterior shoulders. The midwives mentioned no assistants on duty (23.7%) and shortage of oxytocin (20.3%) as some of the hindering factors. During the observation, (66.7%) of the midwives were the only midwife on duty in the labour unit, while (23.3%) had no assistant on duty. A positive relationship exists between their knowledge and practice (P value of 0.000). Their knowledge significantly varies by their academic qualifications (P value of 0.003) but their practice does not significantly differ by their years of experience (P value of 0.075).

Conclusion: a gap exist between the midwives actual practice and evidence based standard practice, thus continuous training, frequent monitoring and supervision on or off notice are necessary to improve their care. Structural support in form of adequate staffing and supply of material are very important to enhance their practice and improve patient care.