Provinsi Sumut sebagai Provinsi ke-enam penyumbang kematian ibu terbanyak di Indonesia, penyebab tertinggi kematian ibu 33% karena perdarahan yang dapat dicegah dengan penerapan Manajemen Aktif Kala III dalam pertolongan persalinan. Berdasarkan penelitian pendahuluan, ditemukan hanya 25% bidan yang menerapkan Manajemen Aktif Kala III sesuai standar. Sisanya 75% tidak melaksanakan Manajemen Aktif Kala III, padahal bidan sebagai tenaga kesehatan utama (70%) yang melakukan pertolongan persalinan.Penelitian ini analitik dengan pendekatan kualitatif, menggunakan metode pengumpulan data melalui wawancara mendalam, observasi dan telaah dokumen. Tujuan dari penelitian ini adalah untuk mengetahui aspek komunikasi, sumberdaya, struktur birokrasi, dan disposisi dalam implementasi kebijakan untuk penerapan Manajemen Aktif Kala III pada bidan di Kota Padangsidimpuan Tahun 2015.Hasil penelitian menunjukkan belum adanya kebijakan yang mengakomodir penerapan MAK III pada bidan, rendahnya pengetahuan bidan tentang MAK III, belum adanya sistem pengawasan terhadap penyelenggaraan bidan praktik swasta menjadi faktor yang sangat mempengaruhi mengapa MAK III sebagai suatu kompetensi penting bagi bidan belum diterapkan. Kedepannya diharapkan adanya kebijakan yang secara tegas mengatur penerapan MAK III pada bidan dari dinas kesehatan dan IBI dalam menurunkan angka kematian Ibu.

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Sumatra Utara Province is the sixth Province of highest Maternal Mortality Rate in Indonesia, this large number of maternal mortality rate is partly caused by bleeding 33%. Bleeding can be prevented by implementing Active Management of the Third Stage of Labor (AMTSL) in childbirth delivery service. However, based on prior research, it shows that only 25% of midwifery implements Active Management of the Third Stage of Labor (AMTSL) according to standards. The rest about 75% of midwives do not perform it, 7% among them has even got APN training, whereas midwives as the main health personnel (70%) do childbirth delivery service.This research is analytic with qualitative approach, the method use in collecting data by doing in-depth interview, observation, and document analysis. The aims of this study are; (1) Getting know about the factors influence the implementation of Active Management of the Third Stage of Labor (AMTSL) at midwives (2) to provide the analysis of policy development to implement Active Management of the Third Stage of Labor (AMTSL) at midwives in Padangsidimpuan city year 2015.The result of study shows that there is no policy that accommodate the implementation of Active Management of the Third Stage of Labor (AMTSL) at midwives yet, less knowledge of midwives about MAK III, and there is no monitoring system related to the implementation of private midwives that tends to be potential factor influence why the Third Stage of Labor as an important competition for midwifery has ignored. Hopefully, the policy development of the implementation Active Management of the Third Stage of Labor (AMTSL) can be as a real effort of District Health Office and IBI in decreasing the Maternal Mortality Rate.