In developing countries, every year the prevalence of HPP is caused by poor labor management, especially at stage III which can cause the mother to lose excessive blood. Midwives, at the forefront of health development, play an important role in increasing the status of maternal health and reducing MMR. One of the basic knowledge and skills of a midwife's competence is the ability to carry out stage III active management to anticipate primary post partum hemorrhage. This study aimed to determine and analyze the performance of midwives in anticipating primary post partum hemorrhage in North Tapanuli Regency. This study is a quantitative study designed with a cross sectional approach. A number of 32 midwives, assisting normal childbirth in October, were taken to be the research samples obtained through purposive sampling technique. The data were analyzed univariately and bivariately with Pearson Product moment correlation and multivariately with multiple linear regression. Through the logistic regression test results, it was found that the education variable had the greatest and most significant influence on the performance of the midwife, followed by knowledge, motivation and experience. The value of R Square was 0.995 so that the coefficient of determination was 99.5%, meaning that the independent variable had a contribution effect of 99.5% on variable Y and 0.5%, other variables were influenced by other factors but were not included in this study.  Conclusion: The variables of education, motivation, experience and knowledge greatly influence the performance of midwives in anticipating primary post partum hemorrhage so that midwives needed to improve their education, motivation, experience and knowledge to produce optimal and professional performance in anticipating primary post partum hemorrhage.