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Abstract
BackgroundThe partograph is the most commonly used labour monitoring tool in the world. However, it has been used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in light of emerging evidence, and they developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore opinions of skilled health personnel on the first version of the WHO Labour Care Guide.MethodsSkilled health personnel (including obstetricians, midwives and general practitioners) of any gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who had worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the sections and variables on the LCG.ResultsA total of 110 participants from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and to have been recorded at the appropriate frequency. Most sections of the LCG were considered complete. Participants agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG could potentially have a positive impact on clinical decision-making and respectful maternity care. Participants disagreed with the value of some variables, including coping, urine, and neonatal status.ConclusionsFuture end-users of WHO Labour Care Guide considered the variables to be clear, relevant and appropriate, and, with minor improvements, to have the potential to positively impact clinical decision-making and respectful maternity care.
Highlights
During the past 20 years, skilled birth attendance has been promoted widely to reduce preventable maternal and perinatal mortality and morbidity [1]
In light of the publication of the 2018 World Health Organization (WHO) recommendations on intrapartum care for a positive childbirth experience, the partograph required a revision to facilitate care according to emerging evidence and global priorities [7]
The first section was for identification, related to the time of diagnosis of active phase of labour, while the other sections were related to different categories of care provided throughout labour and childbirth: supportive care, care of the baby (baseline fetal heart rate (FHR), fetal heart rate” (FHR) deceleration, amniotic fluid, fetal position, caput and moulding), care of the mother, labour progress, medication, shared decision-making, and birth outcomes
Summary
During the past 20 years, skilled birth attendance has been promoted widely to reduce preventable maternal and perinatal mortality and morbidity [1]. In light of the publication of the 2018 World Health Organization (WHO) recommendations on intrapartum care for a positive childbirth experience, the partograph required a revision to facilitate care according to emerging evidence and global priorities [7]. These WHO recommendations include new definitions and durations of the first and second stages of labour, and they highlight the importance of woman-centred care to optimize the experience of labour and childbirth for women and their babies.
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