Date of Award

Winter 1-15-2015

Document Type


Degree Name

Doctor of Education (EdD)


School of Education

First Advisor

Suzanne Harrison, Ph.D.


In Ethiopia, as in many developing countries, postpartum hemorrhage (PPH) is the leading cause of maternal mortality. PPH can be prevented through a three-step practice called active management of the third stage of labor (AMTSL), which can be learned by a skilled birth attendant (SBA). However, most SBAs have not adopted AMTSL into practice. The purpose of this case study was to investigate the use of AMTSL among SBAs in a rural regional hospital in southern Ethiopia. Six theoretical propositions and a conceptual framework were designed to guide the research and analysis. In-depth interviews were conducted with SBAs who worked at the regional hospital in the labor and delivery ward. Internal and external factors of influence on the decision-making process during the management of the third stage of labor by the SBAs were identified and discussed. The participants believe they practice AMSTL despite not meeting criteria. The findings by individual components of AMSTL revealed the use of a uterotonic now considered the most important component in the prevention of PPH. Oxytocin, the uterotonic of choice, was given within the relaxed time frame. Findings of concern suggest a lack of understanding that all women are at risk for PPH and that every woman giving birth should receive AMTSL. An area of even greater concern was the lack of follow-up uterine palpation, which may indicate a lack of patient surveillance during the time of greatest risk. The recommendations for practice show a significant responsibility to improve quality of pre-service and in-service education and training to ensure AMTSL is practiced by every SBA at every birth.