Evaluation of World Health Organization Partograph Implementation by Midwives for Maternity Home Birth in Medan, Indonesia

Objective: to assess the effectiveness of promoting the use of the World Health Organization (WHO) partograph by midwives for labour in a maternity home by comparing outcomes after birth.

Setting: Medan city, North Sumatera Province, Indonesia.

Participants: 20 midwives who regularly conducted births in maternity homes, randomly allocated into two equal groups.

Design: cluster randomised-control trial.

Intervention: under supervision from a team of obstetricians, midwives in the intervention group were introduced to the WHO partograph, trained in its use and instructed to use it in subsequent labours.

Measurements And Findings: there were 304 eligible women with vertex presentations among 358 labouring women in the intervention group and 322 among 363 in the control group. Among the intervention group, 304 (92.4%) partographs were correctly completed. From 71 women with the graph beyond the alert line, 42 (65%) were referred to hospital. Introducing the partograph significantly increased referral rate, and reduced the number of vaginal examinations, oxytocin use and obstructed labour. The proportions of caesarean sections and prolonged labour were not significantly reduced. Apgar scores of less than 7 at 1min was reduced significantly, whereas Apgar scores at 5mins and requirement for neonatal resuscitation were not significantly different. Fetal death and early neonatal death rates were too low to compare.

Implications For Practice: a training programme with follow-up supervision and monitoring may be of use when introducing the WHO partograph in other similar settings, and the findings of this study suggest that the appropriate time of referral needs more emphasis in continuing education.

Conclusion: the WHO partograph should be promoted for use by midwives who care for labouring women in a maternity home.