Active management of the third stage of labor and associated factors among maternity care providers in public health facilities in Eastern Ethiopia: a multi-center study.

Introduction: The third stage of labor is the shortest, most critical, and hazardous stage as it is linked with postpartum hemorrhage, the leading cause of maternal mortality and morbidity. Postpartum hemorrhage can be prevented by 60% with active management of the third stage of labor (AMTSL). Few studies have been conducted in different parts of Ethiopia showing rates of AMTSL ranging from 16.7% to 43.3%. Limited information, however, exists about its practice in our study area. Thus, we aimed to assess the practice of AMTSL and associated factors among maternity care providers in public health facilities in eastern Ethiopia.

Methods: An institution-based cross-sectional study design was used among 270 maternity care providers in public health facilities in eastern Ethiopia. They were recruited using cluster sampling techniques in their health facilities from July 15-October 30/2021. Pretested self-administered questionnaires and an observational checklist were used to collect data. Descriptive, binary, and multivariable logistic regression analyses were performed. Adjusted odds ratios with 95% confidence intervals were used for statistically significant associations.

Results: Good practice of AMTSL occurred in 40.3% (95% CI: 34.5%-46.1%) of births. Being trained (aOR 3.02; 95% CI 1.60-5.70); presence of birth assistance (aOR 2.9; 95% CI 1.42-6.04); having the highest educational level (aOR 4.21; 95% CI 1.08-16.40); and having good knowledge (aOR 3.00; 95% CI 1.45-6.20) were factors statistically associated with maternity care providers' good practice of AMTSL.

Conclusion: Active management of the third stage of labor was practiced with low rates in the study area. Therefore, we suggest that the stakeholders could enhance the presence of birth assistance during all births and provide education to attain higher educational levels and continuously update the maternity care providers' level of knowledge through comprehensive and on-the-job training to increase the good practice of the third stage of labor.