Background: Simulation is one of the most important tools in nursing education for enhancing nurses' knowledge, performance, and self-efficacy in reducing postpartum hemorrhage morbidity and mortality Aim: To investigate the effectiveness of video simulation on increasing maternity nurses' knowledge, practice, and self-efficacy in  managing primary postpartum hemorrhage. Subjects and method: Design: A quasi-experimental research design had utilized. Settings: This study was conducted at the postpartum unit of university hospital and Shebin El-Kom teaching hospital, Menoufia Governorate, Egypt. Subjects: A convenience sampling of 50 maternity nurses who worked in the previous settings and a purposive sample of 100 women with primary postpartum hemorrhage were included. Tools: A structured interviewing questionnaire related to the maternity nurses, a structured interviewing questionnaire related to the postpartum women, an observational checklist for maternity nurses, an observational checklist for postpartum women and self-efficacy scale. Results: The study revealed that there were statistically significant differences between pretest, posttest and follow up after implementation of the video simulation manifested by higher knowledge; practice and self-efficacy score for maternity nurses. Conclusion: Using video simulation for primary postpartum hemorrhage management increased the maternity nurses' knowledge, practice, and self-efficacy scores. Recommendations: Video simulation programs should be included in curriculum to help professional nurses acquire the essential knowledge, performance skills, and clinical judgment for early detection, and an effective nursing response for managing primary postpartum hemorrhage.