Revitalizing the partograph for effective labor monitoring and management in low resource settings

This presentation discusses use of the partograph for effective labor monitoring and management in low-resource settings, based on conclusions and recommendations from an international expert meeting on this issue, co-hosted by EngenderHealth Fistula Care and the Maternal Health Task Force in November 2011. Meeting objectives were to review the evidence for partograph effectiveness, identify barriers to partograph use, develop strategies for overcoming those barriers, and determine future research needs. The partograph is an under-utilized tool for the prevention of obstructed labor: a significant cause of reproductive morbidity and mortality. The WHO recommends its universal use but after more than 50 years of training and investment in such settings, evidence indicates that implementation rates and provider competencies remain low. In short, the partograph has failed to reach its potential as a cheap and simple ‘early warning system' for identifying and managing childbirth complications. The presentation provides an overview of the evidence for partograph effectiveness and describes the major health system challenges to partograph implementation ranging from lack of managerial and logistical support, inadequate referral systems for laboring women to emergency care, chronic shortage of clinically competent trainers and providers and ineffective classroom-based training. It concludes by describing recommendations emerging from the meeting, which advocate for revitalizing the partograph as an essential tool for effective labor management because, despite obstacles, consistent and correct partograph use is perceived to have additional benefits that go beyond effective labor monitoring to improve overall quality of care offered to women and their babies during childbirth.