Midwives Utilization Of Life Saving Skills For Prevention And Management Of Hemorrhage In Primary Health Centers In Anambra State, Nigeria

In Nigeria, 58,000 women die annually of complications of pregnancy and childbirth. Of these deaths, 23.73% are caused by obstetric hemorrhage, which can be prevented with life saving skills (LSS), an early, aggressive, and coordinated intervention for prevention and management of hemorrhage. This study assessed the midwives' knowledge and practice of LSS among 177 Nigerian midwives at 126 primary health centers. Data were collected using a self-administered questionnaire and observation checklist. Finding indicated 52.5% of the midwives were highly knowledgeable about LSS. However, although 70.6% self-reported a high level of implementing LSS procedures, only 21.7% of the midwives observed actually demonstrated a high level of implementation. The majority practiced some LSS components, including early clamping and cutting the cord (95%) and uterine massage (73.3%); all administered oxytocin, most frequently when delivering the anterior shoulders. The midwives reported numerous challenges to implementing LSS, including lack of an assistant when on duty (23.7%) and shortage of oxytocin (20.3%). These limitations were confirmed by on-site observation in which 66.7% were the sole midwife on duty and 23.3% had no assistant available. A positive relationship was found between midwives' knowledge and practice, with knowledge varying by academic qualifications. However, practice patterns did not differ by years of experience. These findings indicate a gap exists between the midwives' actual practice and evidence-based practice standard. Therefore, continuous training, frequent monitoring, and supervision are necessary to improve regular implementation of LSS in practice.