261612 Revitalizing the partograph for effective labor monitoring and management in low resource settings

Monday, October 29, 2012

Celia Pett, Registered Nurse/Midwife , Fistula Care Project, EngenderHealth, New York, NY
Joseph Ruminjo, MBChB, MMed O/G , Fistula Care, EngenderHealth, New York, NY
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.

Learning Areas:
Administration, management, leadership
Program planning
Provision of health care to the public
Public health or related nursing
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
1. Evaluate evidence for effectiveness of partograph as a tool for labor monitoring and management in low resource settings 2. Describe challenges to partograph implementation in low resource settings 3. Discuss recommendations for revitalizing the partograph to improve quality of care in childbirth

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a nurse-midwife with over twenty years of experience in low and middle income countries. I am a medical associate on the Fistula Care project of EngenderHealth, a leading global reproductive health organization that works with governments and communities in more than twenty countries to improve the quality of health care and advocate for sound practices and policies to support sexual and reproductive health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.