Recommended and Non-recommended Intrapartum Care Practices among Obstetric Care Providers in Hospitals of Wollega Zones, Oromia, Ethiopia: A Direct Observation Study

Background High-quality intrapartum care requires both consistent delivery of beneficial practices and avoidance of interventions that are not recommended for routine use. Evidence on the practice-level pattern of these two dimensions remains limited in western Ethiopia. Methods We conducted a facility-based cross-sectional observational study from 20 January to 20 April 2022 in 11 hospitals across the four Wollega zones of Oromia, Ethiopia. All 278 eligible obstetric care providers included in the parent study were observed using a 27-item checklist adapted from WHO Intrapartum care recommendations. Recommended practices were summarized as the proportion of observed providers performing each beneficial action, whereas non-recommended practices were summarized as the proportion observed performing the routine intervention. As an analytical component, we report the parent study’s multivariable logistic regression for overall evidence-based intrapartum care, clearly identified as previously reported contextual analysis rather than a new item-level regression. Results Recommended practices varied substantially. Prophylactic oxytocin (78.5%), controlled cord traction (77.0%), vitamin K prophylaxis (76.4%), early breastfeeding (75.3%), perineal-trauma prevention (73.5%), support for spontaneous pushing (72.4%), and oral intake (71.4%) were frequently observed. Lower-performing recommended practices included opioid analgesia (41.5%), relaxation techniques (53.8%), manual pain-management techniques (59.3%), immediate postpartum assessment (60.0%), maternal mobility (61.5%), and four-hourly vaginal examination (61.8%). Among non-recommended practices, sustained uterine massage after prophylactic oxytocin (69.9%) and routine nasal/oral suctioning of spontaneously breathing neonates (63.9%) were common; routine amniotomy (45.0%) and routine antibiotic prophylaxis after uncomplicated vaginal birth (44.6%) were also frequent. In the parent analysis, higher education, good knowledge, positive attitude, availability of updated guidelines, ≥5 providers per shift, and <10 deliveries/day were independently associated with overall evidence-based practice. Conclusion The observed pattern reflects simultaneous underuse of important recommended care and persistent use of non-recommended routine interventions. Quality improvement should therefore target both implementation gaps and de-implementation of unnecessary practices through audit and feedback, accessible guidelines, competency-based training, supportive supervision, and workload-sensitive staffing.