Partograph Meeting Reflections

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At the technical meeting on partograph use earlier this month a wide variety of opinions were heard about the appropriateness of the tool, how to increase its coverage, and many other topics. Over the coming days, we’ll be posting some reflections on the meeting from experts who attended.

Suzanne Stalls, from the American College of Nurse-Midwives, writes:

All clinicians at the meeting agreed that a basic tenet of skilled labor and birth attendance is to monitor the progress of labor and take timely and appropriate action to avoid significant morbidity/mortality of the woman and infant. Given that, we then have to answer the next question: how can this best be achieved? To date, clinicians have developed two mechanisms for monitoring labor—the partograph and the electronic fetal monitor. While all can agree that neither are perfect, ultimately we have to evaluate the tools that are available within the reality of the settings. In a resource-constrained environment with multiple systems issues, our thoughts were to 1) assume that use of the tool is important; 2) look at what are the factors that can enable more consistent and effective use on a day to day basis; 3) evaluate what the systems issues are that, if resolved, would contribute to greater uptake; 4) bear in mind that a large percentage of women do not go to facilities to give birth; and 5) look at re-packaging the partograph, both in “selling” its use to overworked, under-resourced health care workers and in viewing the tool as a way of enhancing both clinical care of the woman and in the perception of the woman’s and family’s level of care received at the facility.

Florence Gans-Lartey, of the Presbyterian Nurses Training College in Ghana, adds:

The WHO partograph is a good monitoring and managing tool that, if appropriately used by midwives, obstetric nurses and doctors (skilled birth attendants), can assess maternal/foetal wellbeing and provide ongoing monitoring to detect obstructed labour. However, the extent to which the partograph is used in low resourced countries, including Ghana and the conditions under which it is used still remain unclear. lt is imperative that all skilled birth attendants acquire periodic pre-service and in-service training and supervision on the appropriate use of the partograph. Providers must be committed to using this tool to help make early decision on the labouring woman and for appropriate action.

Stay tuned for more thoughts from meeting participants coming soon.