Exploring Midwives’ Experiences and Practices of Active Management of the Third Stage of Labour at Northern Regional Hospital, Ghana

Abstract

Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality globally and in Ghana. Active Management of the Third Stage of Labour (AMTSL) is a proven intervention for preventing PPH, yet its consistent implementation in clinical practice remains a challenge, particularly in resource-limited settings. The study aimed to explore midwives’ experiences and practices of AMTSL at Northern Regional Hospital, Tamale. Methods: An exploratory descriptive qualitative design was adopted. Fourteen registered midwives working in the labour ward, maternity ward, and antenatal clinic were purposively selected. Data were collected through in-depth interviews, transcribed verbatim, and thematically analyzed using Braun and Clarke’s framework. Reflexivity and Lincoln and Guba’s trustworthiness criteria ensured methodological rigour. Results: Midwives demonstrated strong knowledge of AMTSL and consistently administered oxytocin within one minute after birth, reflecting adherence to the most critical step. However, uterine massage and controlled cord traction were applied inconsistently, mainly due to staff shortages, heavy workload, concerns about oxytocin potency during power outages, and limited refresher training. Despite these challenges, midwives expressed a strong commitment to maternal safety and proposed practical solutions, including regular refresher training, improved staffing, reliable logistics, and supportive supervision. Conclusion: Midwives expressed strong commitment to maternal safety and proposed practical solutions including regular refresher training, improved staffing, reliable logistics, supportive supervision, and targeted educational programs addressing knowledge gaps.