From Visual Estimation to Bundled Care: Previous Postpartum Haemorrhage Practices, Experiences and Perceived Effectiveness of the E-MOTIVE Bundle among Healthcare Providers in Ondo State, Nigeria (Published)
Postpartum haemorrhage (PPH) is a leading cause of maternal death, and Nigeria accounted for 28.7% of global maternal deaths in 2023. The E-MOTIVE bundle, pairing objective blood-loss measurement with standardised first-response treatment, is being scaled up in Ondo State, but evidence on the practices it replaces and on providers’ experiences is limited.To describe healthcare providers’ previous methods of PPH prevention and management, and to explore their experiences of, and the perceived effectiveness of, the E-MOTIVE bundle in Ondo State. A sequential exploratory mixed-methods study was conducted in nine designated facilities. Key informant interviews with 18 purposively selected doctors, nurses and midwives were analysed thematically using NVivo 11. A structured electronic questionnaire was completed by 208 providers selected by multistage sampling and analysed descriptively. Findings were integrated using a joint display. Before E-MOTIVE, providers reported near-universal active management of the third stage of labour, including uterotonic administration (98.1%), controlled cord traction (99.0%) and uterine massage (96.2%), whereas balloon tamponade (50.5%) and the non-pneumatic anti-shock garment (57.2%) were less used. Interviews revealed reliance on visual estimation of blood loss, repeated sequential uterotonic doses and referral when bleeding persisted. Since adoption, providers described averted maternal deaths and perceived the bundle as effective for accurate blood-loss measurement, earlier detection, reduced need for transfusion and surgery, and improved maternal outcomes. The E-MOTIVE bundle addresses the diagnostic and sequencing gaps of previous practice and is perceived as highly effective. Sustained training, commodity supply and outcome surveillance are needed to confirm these benefits.
Keywords: E-MOTIVE, Maternal Mortality, Mixed Methods, Nigeria, Postpartum haemorrhage, calibrated drape