More participants from the partograph meeting share their reflections.
Dr. Barbara E. Kwast, a consultant on maternal health and safe motherhood writes:
There has to be a goal in the form of a minimum standard that we all must advocate for and that is a district health system with access for all to a qualified midwife/attendant and a referral system that ensures safe care for complicated pregnancies and labours. This has to include the use of a partograph. Poor implementation of the partograph does not mean that the partograph is not good. It provides a clear picture of all aspects of progress of labor, enhances teamwork and referral provided there is a management protocol and a functioning district health system. There is evidence that prolonged labour can be reduced, augmentation rates can be changed and Cesarean sections can be reduced, all leading to improvement of quality of care and empowerment of midwives to interpret labor progress and decision making. Broken health systems must be fixed and communities must be educated to recognize dangers of prolonged labor once they have access to emergency obstetric care.
More from Suzanne Stalls at the American College of Nurse-Midwives:
When reviewing the ICM essential competencies for midwifery practice, we made note of the language used in the document as follows: ‘The midwife has the knowledge and/or understanding of how to use the partograph and monitor progress of labour using the partograph or similar tool for recording’
Prior to reviewing the document, the participants at the meeting had discussed that one of the issues surrounding the partograph is its under-utilization. The partograph has four functions, all of which can be extremely useful to provider, facility and client, if appropriately applied. Those four functions are: a management tool for clinical decision making, a referral tool, an audit tool and a record keeping tool. The partograph has most often been used as a record keeping tool, even to the extent that it is filled out retrospectively. Women and families, particularly in a low-resource setting, would be better served, however, by utilizing the tool as a management tool for clinical decision making and as a referral tool so that action can be taken when labor progress deviates from the norm and wise clinical decisions can be made. In thinking about the customary use of the partograph and reflecting upon the language used in the essential competencies, we wondered if a key element of teaching about the partograph is missing. That element is one of the more difficult concepts to convey in adult learning but without it, a sound clinician isn’t born. Critical thinking skills which lead to appropriate clinical decisions are at the foundation of any training or education of health care workers.