A cross-sectional study measuring management of third stage of labour by midwives and maternity nurses in Oman

Abstract

Abstract Background The World Health Organisation (WHO) recommends implementing evidence-based active management of the third stage of labour (AMTSL) guidelines for all women during the third stage of labour (TSL). Midwives and maternity nurses play a major role in the management of third stage of labour and prevention of postpartum haemorrhage.Aim To investigate midwives' and maternity nurses' knowledge, attitude and self-reported practices in Oman towards management of third stage of labour and factors that influence implementation of AMTSL guidelines.Methods A cross-sectional survey of 300 midwives and maternity nurses working in childbirth wards in six hospitals in Oman between July and September 2019. Descriptive statistics and binary logistic regressions were used to identify the factors associated with knowledge, attitude and self-reported practice.Results The survey achieved a response rate of 80% (n = 240; 231 midwives and 9 maternity nurses). Just over half of the respondents (n = 132, 55%) correctly identified the core characteristics of the recommended management of TSL of WHO guidelines. Fewer respondents correctly identified specific components of AMTSL, such as the administration of recommended dose of oxytocin following birth (n = 108, 45%), cord clamping and cutting (n = 130, 54.2%) and no continuous uterine massage (n = 23, 9.6%). Regarding self-reported practice, 149 respondents (62%) reported always adhering to the AMTSL guidelines. Staff age and years of experience in the birthing ward were both independently associated with knowledge that was consistent with the WHO guidelines (p = 0.05). Hospital type, job title and staff age were associated with self-reported adherence to WHO guidelines (p = 0.05). Participants in all hospital types consistently identified lack of time and staff shortages as barriers to guidelines implementation.Conclusions There is a gap between knowledge and self-reported practice in the management of the third stage of labour, and between international WHO guidelines and current maternity care in Oman. This study provides insights for nursing and midwifery leaders and policymakers and informs future workforce training and strategies.