Midwives Preparedness in Management of Postpartum Hemorrhage in Muranga County, Kenya
Muthoni, Doris Mumbi
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ABSTRACT Postpartum hemorrhage is the cumulative blood loss of about 500 milliliters in a spontaneous vagina delivery and approximately 1,000 milliliters for cesarean section birth and is one of the leading causes of maternal mortality. World Health Organization estimates that more than 300,000 women world-wide died from pregnancy-related cases in 2015, which means a total of 830 women die every day. In Kenya, it translates to 362 deaths per 100,000 live births. Postpartum hemorrhage is the major cause of maternal mortality resulting to a woman dying every 4 min, worldwide due to massive PPH. It is more tragic to have a well mother dying in the process of giving birth with complications that can be prevented. A woman’s death has some negative impact on the family, community, and the government due to the role the mother plays in a home setup. In view of the above a study was conducted in Muranga County with an objective of determining the preparedness of midwives in prevention and management of PPH. The study adopted a descriptive cross-sectional study that employed a quantitative approach through the use of a research self-administered questionnaire and an observational checklist targeting midwives. A total of 85 midwives filled the questionnaire and 71 midwives were observed respectively. The convenience sampling technique was used to select the midwives in the study sites. The analysis was done using SPSS. The study findings showed midwives factors that had an association in their preparedness in the management of PPH as follows: age ( p-value= 0.021), professional qualification (P-value= 0.047), experience in the management of PPH (P= 0.032) and training on emergency management of PPH (P= 0.010). Midwives knowledge that influenced their preparedness in the management of PPH was knowledge on; uterotonics use ( Fischer’s exact value= 0.000), recommended time for uterotonic drug administration (P= 0.043), uterine massage during 3rd stage of labour (P= 0.012), examination of the placenta (P= 0.034), management of PPH (P= 0.028), causes of PPH (P= 0.001) and on diagnosing PPH (Fischer’s exact value= 0.043). Institutional factors influencing the midwives preparedness in the management of PPH were availability of uterotonic supplies (P= 0.040), availability of transport in case of a referral (P= 0.032), staff to patient ratio (P= 0.028), and availability of Management guidelines (P= 0.012). On current practice deliveries observed showed, 27.2% competently prepared for birth, 18.3% offered emotional support, 26.2% competently prepared for the second stage, 35.5% administered uterotonics, 25.9% practiced controlled cord traction and 27.1% performed uterine massage. Finally, the study concluded that Midwives factors, institutional factors, and the use of current guidelines influence midwives preparedness in the management of PPH. The study recommends that the county government be providing continuous training to midwives on emergency management of PPH, ensure the availability of equipment, uterotonic drugs and transport facilities in case of referral. Also the Ministry of Health should provide current Standard Management Guidelines on PPH, orientate the midwives on their usage and ensure the guidelines are displayed.