Usability, acceptability, and feasibility of the World Health Organization Labour Care Guide: A mixed‐methods, multicountry evaluation

Abstract

Introduction The World Health Organization’s (WHO) Labour Care Guide (LCG) is a “next‐generation” partograph based on WHO’s latest intrapartum care recommendations. It aims to optimize clinical care provided to women and their experience of care. We evaluated the LCG’s usability, feasibility, and acceptability among maternity care practitioners in clinical settings. Methods Mixed‐methods evaluation with doctors, midwives, and nurses in 12 health facilities across Argentina, India, Kenya, Malawi, Nigeria, and Tanzania. Purposively sampled and trained practitioners applied the LCG in low‐risk women during labor and rated experiences, satisfaction, and usability. Practitioners were invited to focus group discussions (FGDs) to share experiences and perceptions of the LCG, which were subjected to framework analysis. Results One hundred and thirty‐six practitioners applied the LCG in managing labor and birth of 1,226 low‐risk women. The majority of women had a spontaneous vaginal birth (91.6%); two cases of intrapartum stillbirths (1.63 per 1000 births) occurred. Practitioner satisfaction with the LCG was high, and median usability score was 67.5%. Practitioners described the LCG as supporting precise and meticulous monitoring during labor, encouraging critical thinking in labor management, and improving the provision of woman‐centered care. Conclusions The LCG is feasible and acceptable to use across different clinical settings and can promote woman‐centered care, though some design improvements would benefit usability. Implementing the LCG needs to be accompanied by training and supportive supervision, and strategies to promote an enabling environment (including updated policies on supportive care interventions, and ensuring essential equipment is available).

WHO Labor Care Guide as the next generation partogram: Revolutionising the quality of care during labor

“…This is a timely need as the traditional WHO partogram failed to show any significant clinical benefit 2 . As published by Vogel et al 3 , this LCG might possibly revolutionize labor monitoring in a woman-centered manner with shared-decision making. In their mixed-methods study, aspects pertaining to utility, acceptability, anticipated challenges and barriers have been discussed 3 .…”

“…As published by Vogel et al 3 , this LCG might possibly revolutionize labor monitoring in a woman-centered manner with shared-decision making. In their mixed-methods study, aspects pertaining to utility, acceptability, anticipated challenges and barriers have been discussed 3 . Its integration of items to promote and monitor positive birth experience is a worthwhile effort.…”

“…Despite being more robust, the existing partogram should not be replaced completely and suddenly. Vogel et al 3 have also raised a few negative points in their qualitative findings. These include added workload, lack of a pictorial overview which leads to consuming more energy to interpret, tiny space to write, lack of staff and being reluctant to accommodate a labor companion of choice, etc.…”

“…Alternatively, women in the latent phase can also be included into the labor wards, as within the next few hours their labor can swiftly move into the active phase. It has been reported that updating of national policies relating to the physical layout of existing labor wards, equipment and medical supplies and standard protocols for intrapartum care, is a requirement to gain the expected benefits from this WHO LCG 3 . Arranging labor companion of choice, (‘doula’) which is a proven healthy intervention in labor support 8 , is another challenge in some settings 9 .…”

“…These include added workload, lack of a pictorial overview which leads to consuming more energy to interpret, tiny space to write, lack of staff and being reluctant to accommodate a labor companion of choice, etc. 3 The introduction and replacement should be a gradual process with continuous audits and quality assessment. The need for training sessions, supervision, context-specific changes in each country, and practical ways of monitoring latent phase women, need to be emphasized.…”