Investigating evidence-based third stage of labour management among midwives and maternity nurses: A cross-sectional study

Background: Midwives and maternity nurses use evidence-based active management of the third stage of labor (AMTSL), a practice recommended by the World Health Organization, which is crucial for preventing postpartum hemorrhage (PPH). This study investigates the knowledge, attitudes, and practices of Omani midwives and maternity nurses regarding third-stage labor management and the factors affecting the implementation of evidence-based AMTSL guidelines. Methods: A cross-sectional study was conducted with 300 midwives and maternity nurses from six Omani hospitals with varying care levels. Convenience sampling was used to collect the data using a validated questionnaire and the Prevention of PPH Initiative Checklist. The analyses included frequencies, binary logistic regression, and Fisher’s exact test ( P < 0.05). Results: With an 80% response rate ( n = 240; 9 maternity nurses, 231 midwives), 39.2% correctly identified all AMTSL components and 62% reported full adherence, although oxytocin was often delayed. Knowledge and adherence were associated with age (<34 years: adjusted odds ratio [AOR] =2.6; >45 years: AOR = 3.1) and experience (≥5 years: AOR = 3.1). Full adherence (62%, n = 149) was higher in tertiary hospitals (AOR = 1.8) and maternity nurses (AOR = 1.9). Staffing shortages and high workloads have hindered implementation, emphasizing the need for better staffing and training. Conclusion: Omani midwives and maternity nurses need improved education, training, staffing, and updated policies to bridge the gap in knowledge and practice regarding evidence-based third stage of labor management. This study offers valuable insights for future research and evaluation.