Background: Maternal morbidity and mortality have been a major issue for decades, despite different avenues and programmes created to reduce it; the rate of improvement remains slow. Haemorrhage being the leading cause can be prevented if every third stage of labour is actively managed. Many studies have proved that active management of third stage of labour is effective. This study was designed to assess knowledge and utilization of active management of third stage of labour (AMTSL) by midwives in primary health centres (PHC) as well as the factors influencing the practice. Methodology: The descriptive study consisted of 177 midwives from 15 purposively selected Local Government Areas (L.G.A) of Anambra State. The instruments for data were collection structured questionnaire and an observational checklist. The questionnaire assessed knowledge, utilization and factors affecting the practice of AMTSL while the observational checklist was used to assess the actual practice of the midwives. Result The result showed that the majority of the respondents have high (66.7%) and moderate (28.2%) knowledge. Almost all respondents (78%) reported frequent practice of AMTSL but surprisingly on observation, they do not. Many practiced some segments of AMTSL like injection of oxytocin, early clamping and cutting of the cord and uterine massage. Lack of assistants on duty; non availability of oxytocin; non-compliance of patients and long procedural time were the hindering factors identified. Recommendations: Periodic workshops and seminars, frequent monitoring and supervision of midwives with or without notice to assess their practices will be beneficial for ensuring safety of lives and improving quality of care.