Role of Midwives in the Prevention and Management of Postpartum Hemorrhage

1.0 Introduction

1.1 Background of Study

The role of midwives in childbirth and maternal healthcare dates back centuries, with historical evidence showing that midwifery has been a critical profession in ensuring safe deliveries and postpartum care. In ancient civilizations, such as Egypt and Greece, midwives were recognized as skilled caregivers who assisted women during labor and childbirth, providing remedies to manage bleeding and other complications (Loudon, 2000). Traditional midwifery practices involved herbal treatments, massage techniques, and the use of manual methods to prevent excessive bleeding after birth. During the Middle Ages, midwifery continued to evolve, but practices varied widely depending on cultural beliefs and medical knowledge. In many regions, midwives relied on traditional knowledge passed down through generations. However, with the advent of formal medical education in the 18th and 19th centuries, midwifery began to be integrated into the broader healthcare system. The discovery of uterotonic agents, such as ergot derivatives, in the early 19th century marked a significant advancement in the prevention of postpartum hemorrhage (Dunn, 2003).

Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide, particularly in low- and middle-income countries where access to timely obstetric care is often limited. The World Health Organization (WHO) estimates that PPH accounts for approximately 27% of global maternal deaths, with the highest burden occurring in sub-Saharan Africa and South Asia (WHO, 2023). Despite advancements in maternal healthcare, the prevalence of PPH remains a major concern, underscoring the need for effective preventive and management strategies.

Midwives play a central role in maternal healthcare by providing skilled care during pregnancy, childbirth, and the postpartum period. Their involvement in the prevention and management of PPH is critical, as they are often the first responders in labor and delivery settings. Active management of the third stage of labor (AMTSL), which includes the administration of uterotonic drugs such as oxytocin, controlled cord traction, and uterine massage, is one of the most effective strategies employed by midwives to reduce the incidence of PPH (Begley et al., 2019).

Renfrew et al. (2014) articulated that, midwives contribute significantly to maternal health education by informing women about risk factors associated with PPH, the importance of antenatal care, and the need for skilled birth attendance. Studies have shown that increasing access to trained midwifery services can lead to a significant reduction in maternal mortality rates by ensuring timely and appropriate management of obstetric complications (Renfrew et al., 2014). However, challenges such as inadequate resources, poor healthcare infrastructure, and workforce shortages continue to hinder midwives' ability to provide optimal care in many regions.

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in low-resource settings. The World Health Organization (WHO) defines postpartum hemorrhage as the loss of 500 mL or more of blood within the first 24 hours after childbirth, or 1,000 mL or more in cases of severe PPH (WHO, 2023). It remains a critical obstetric emergency, accounting for approximately 27% of maternal deaths globally (Say et al., 2014). Midwives play a crucial role in the prevention, early detection, and management of PPH, as they are often the primary healthcare providers during childbirth. Their responsibilities include active management of the third stage of labor (AMTSL), timely administration of uterotonic drugs, and rapid intervention when complications arise (ICM, 2022). Therefore, this research study examines the role of midwives in preventing and managing postpartum hemorrhage.

1.2 Statement of Problems

Investigation revealed that many health facilities are understaffed, leaving midwives overwhelmed with high patient loads and limited resources to provide adequate care (UNFPA, 2022). In some cases, midwives are not adequately trained in active management of the third stage of labor (AMTSL), which is a key strategy for preventing PPH. The lack of continuous professional training and access to updated clinical guidelines further compounds the problem (Renfrew et al., 2014).

Furthermore, delays in recognizing and responding to PPH also contribute to poor outcomes. In some settings, midwives face difficulties in diagnosing Postpartum Hemorrhage early due to inadequate monitoring tools or insufficient knowledge among birth attendants. Limited collaboration between midwives and other healthcare professionals can further delay emergency interventions, reducing the chances of survival for affected mothers (WHO, 2023). It is against the backdrop that this study seeks to address these problems by exploring midwifery-led interventions, challenges faced in resource-limited settings, and policy recommendations for strengthening midwifery services to enhance maternal health outcomes.

1.3 Aim and Objectives of Study

The aim of this study is to examine the role of midwives in the prevention and management of postpartum hemorrhage (PPH).

The specific objectives of the study are:

1. To evaluate the availability and accessibility of essential medications and equipment used by midwives in PPH management.
2. To examine the challenges midwives face in implementing evidence-based interventions for PPH prevention and treatment.
3. To assess the knowledge and practices of midwives in preventing and managing postpartum hemorrhage.
4. To explore the impact of midwifery-led care on reducing maternal mortality related to postpartum hemorrhage.
5. To provide recommendations for strengthening midwifery education, training, and policy support to enhance PPH management.

1.4 Research Questions

Based on the stated objectives, the following research questions will guide this study:

• What is the level of knowledge and practice of midwives in preventing and managing postpartum hemorrhage?
• How available and accessible are essential medications and equipment used by midwives for PPH management?
• What challenges do midwives face in implementing evidence-based interventions for the prevention and treatment of PPH?
• How does midwifery-led care contribute to reducing maternal mortality related to postpartum hemorrhage?
• What recommendations can be made to strengthen midwifery education, training, and policy support for improved PPH management?

1.5 Research Hypothesis

Based on the stated objectives, the following hypotheses are formulated:

• H₀1: There is no significant relationship between midwifery-led care and the reduction of maternal mortality related to postpartum hemorrhage.
• H₀2: Midwives' knowledge and practices significantly influence the prevention and management of postpartum hemorrhage.
• H₀3: The availability and accessibility of essential medications and equipment positively affect midwives' ability to manage postpartum hemorrhage.
• H₀4: Challenges faced by midwives, such as inadequate training and resource limitations, negatively impact the effective management of postpartum hemorrhage.

1.6 Significance of Study

The outcome of this research will contribute to strengthening midwifery education and training programs by identifying gaps in knowledge and practice related to postpartum hemorrhage (PPH) management. The study will also inform policymakers and healthcare administrators on the need to improve the availability and accessibility of essential medications and equipment for PPH prevention and treatment.

Furthermore, this research will serve as a reference for future studies on maternal health, midwifery practice, and postpartum hemorrhage management. It will create awareness among stakeholders, including healthcare providers, expectant mothers, and communities, on the importance of skilled midwifery care in preventing life-threatening postpartum complications.

1.7 Scope of Study

This study focuses on the role of midwives in the prevention and management of PPH in Lagos State, Nigeria. It will examine midwives working in selected public and private healthcare facilities, including Lagos University Teaching Hospital (LUTH), General Hospital Lagos, and selected primary healthcare centers.

1.8 Limitations of the study

During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
3. Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.

1.9 Definition of Terms

Midwife: A midwife is a trained healthcare professional who specializes in providing care to women during pregnancy, childbirth, and the postpartum period. Midwives play a critical role in ensuring safe deliveries and managing complications such as postpartum hemorrhage (WHO, 2022).

Postpartum Hemorrhage (PPH): Postpartum hemorrhage is defined as excessive bleeding of 500 mL or more after vaginal delivery or 1,000 mL or more after a cesarean section within 24 hours of childbirth. It is one of the leading causes of maternal mortality worldwide (FIGO, 2021).

Prevention of PPH: The prevention of postpartum hemorrhage involves proactive measures such as active management of the third stage of labor, timely administration of uterotonic drugs (e.g., oxytocin), and ensuring proper maternal nutrition and hydration (WHO, 2020).

Management of PPH: The management of postpartum hemorrhage includes immediate interventions such as uterine massage, administration of medications to control bleeding, fluid replacement therapy, and, in severe cases, surgical procedures like hysterectomy (Rath et al., 2022).

Uterotonic Drugs: Uterotonic drugs are medications used to stimulate uterine contractions and reduce postpartum bleeding. Common uterotonics include oxytocin, misoprostol, and ergometrine (ICM, 2021).