Integration of the practice of active management of the third stage of labor within training and service implementation programming in Zambia

J Midwifery Womens Health. 2010 Sep-Oct;55(5):447-54. doi: 10.1016/j.jmwh.2010.02.015.


Introduction: Postpartum hemorrhage (PPH) is the leading cause of pregnancy-related mortality (cited at 591 per 100,000 Zambian women), and is responsible for up to 60% of maternal deaths in developing countries. Active management of the third stage of labor (AMTSL) has been endorsed as a means of reducing the risk of PPH. The Ministry of Health/Zambia has incorporated the use of AMTSL into its reproductive health guidelines.

Methods: Midwives employed in five public hospitals and eight health centers were interviewed (N = 62), and 82 observations were conducted during the second through fourth stages of labor.

Results: Data from facilities in which oxytocin was available (62 births in 11 settings) indicated that a uterotonic was used in 53 of the births (85.5%); however, AMTSL was conducted in strict accord with the currently recommended protocol (a time-specific use of the uterotonic, controlled cord traction, and fundal massage) in only 25 (40.4%) of births.

Discussion: Midwives have concerns about risks of maternal to newborn HIV blood transfusion; it is doubtful that they will adopt the currently recommended practice of delayed cord clamping and cutting. Infrastructure issues and supply shortages challenged the ability to correctly and safely implement the AMTSL protocol; nevertheless, facilities were generally ready to support it.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Hemostatic Techniques
  • Humans
  • Labor Stage, Third*
  • Middle Aged
  • Midwifery / methods*
  • Oxytocics / therapeutic use*
  • Postpartum Hemorrhage / epidemiology
  • Postpartum Hemorrhage / prevention & control*
  • Practice Guidelines as Topic
  • Pregnancy
  • Risk Factors
  • Umbilical Cord
  • Uterus / blood supply*
  • Zambia


  • Oxytocics