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Effect of Postpartum Haemorrhage Education on Emergency Management Knowledge among Midwives in Nigeria

Abstract

Postpartum haemorrhage (PPH) is a major obstetric emergency and an important cause of maternal morbidity and mortality, particularly when excessive bleeding is not recognized and managed promptly. Midwives play a critical role in the prevention, early recognition, assessment, and emergency management of postpartum haemorrhage because they are frequently involved in childbirth, immediate postpartum monitoring, and the initial response to obstetric emergencies. Postpartum haemorrhage education provides midwives with knowledge and practical information relating to the causes and risk factors of PPH, recognition of excessive postpartum bleeding, assessment of maternal condition, estimation and monitoring of blood loss, uterine assessment, initial emergency interventions, appropriate use of medications according to approved protocols, fluid and blood replacement principles, escalation of care, referral, documentation, and multidisciplinary emergency response. Emergency management knowledge refers to midwives' understanding of the principles, priorities, procedures, and appropriate interventions required to recognize, stabilize, and manage women experiencing postpartum haemorrhage. In Nigeria, inadequate access to regular PPH education, shortages of essential medicines and emergency supplies, limited blood availability, staff shortages, high workloads, inconsistent access to standardized obstetric emergency protocols, and referral delays may affect midwives' preparedness to manage PPH effectively. Effective PPH education may improve midwives' knowledge, clinical decision-making, confidence, and preparedness to respond promptly to obstetric haemorrhage. Against this background, this study investigates the effect of postpartum haemorrhage education on emergency management knowledge among midwives in Nigeria. The study is anchored on Social Cognitive Theory, Experiential Learning Theory, and the Knowledge-Attitude-Practice framework. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping midwives' emergency response behaviour. Experiential Learning Theory emphasizes learning through practical experience, demonstration, simulation, reflection, and application, making it particularly relevant to obstetric emergency education. The Knowledge-Attitude-Practice framework provides a basis for examining how structured PPH education may improve knowledge and preparedness for emergency management. Collectively, these theoretical perspectives provide a suitable framework for explaining how PPH education may influence emergency management knowledge among midwives in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from midwives providing maternity and obstetric care in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire, PPH knowledge assessment, and standardized clinical case scenarios. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, maternity units, and eligible midwives. Where feasible, selected healthcare facilities or midwife groups will be assigned to intervention and comparison groups. Midwives in the intervention group will receive structured PPH education covering the causes and risk factors of postpartum haemorrhage, recognition of excessive postpartum bleeding, maternal assessment, blood-loss monitoring, uterine assessment, initial emergency interventions, appropriate medication use according to approved protocols, fluid and blood replacement principles, escalation of care, referral, documentation, and multidisciplinary emergency response. Emergency management knowledge will be assessed using indicators such as identification of PPH, recognition of maternal deterioration, assessment of blood loss, uterine assessment, knowledge of immediate emergency interventions, appropriate escalation, referral procedures, and coordination of emergency care. Clinical case scenarios will be incorporated to assess midwives' ability to apply emergency management knowledge to realistic PPH situations. Descriptive statistics will be used to summarize midwives' sociodemographic and professional characteristics, previous obstetric emergency training, exposure to PPH education, and emergency management knowledge scores. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple regression analysis, will be used to determine the effect of PPH education on emergency management knowledge. Where appropriate, pre-intervention and post-intervention knowledge scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that PPH education has a significant positive effect on emergency management knowledge among midwives in Nigeria. Midwives exposed to structured PPH education are expected to demonstrate improved knowledge of PPH risk factors, recognition of excessive bleeding, maternal assessment, blood-loss monitoring, uterine assessment, emergency interventions, escalation of care, and referral procedures. Education may strengthen midwives' ability to recognize postpartum haemorrhage promptly and understand the appropriate sequence and priorities of emergency management. Simulation-based and case-based education may further improve knowledge retention and clinical decision-making by allowing midwives to apply PPH management principles to realistic obstetric emergencies. However, education alone may not guarantee effective PPH management because midwives may continue to face barriers such as inadequate staffing, shortages of essential medicines and emergency supplies, limited blood availability, inadequate equipment, delayed referrals, and weak emergency response systems. Consequently, PPH education is expected to be most effective when supported by regular simulation-based training, functional emergency equipment, adequate supplies, blood availability, standardized obstetric emergency protocols, supportive supervision, and effective referral systems. The study is expected to contribute to the literature on postpartum haemorrhage, obstetric emergencies, midwifery education, maternal health, emergency management, maternal mortality prevention, healthcare worker competency, and public health in Nigeria by providing empirical evidence on the effect of PPH education on emergency management knowledge among midwives. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, National Primary Health Care Development Agency, hospitals, maternity facilities, Nursing and Midwifery Council of Nigeria, midwifery training institutions, professional associations, maternal health programmes, development partners, and policymakers regarding strategies for strengthening midwives' capacity to respond to postpartum haemorrhage. The study will also provide evidence-based recommendations for integrating PPH education into midwifery education and continuing professional development, expanding simulation-based obstetric emergency training, conducting regular competency assessments, ensuring availability of essential emergency medicines and equipment, strengthening blood transfusion and referral systems, and improving emergency preparedness for postpartum haemorrhage in Nigerian healthcare facilities.

Keywords: Postpartum haemorrhage education, emergency management knowledge, midwives, Nigeria, postpartum haemorrhage, obstetric emergency, maternal health, emergency management, midwifery education, maternal mortality, obstetric care, clinical training, emergency preparedness, public health.