LABOUR MANAGEMENT USING THE. GUIDE.pptx

LABOUR MANAGEMENT USING THE. GUIDE

1. LABOUR MANAGEMENT USING THE WORLD HEALTH ORGANIZATION LABOUR CARE GUIDE BY DRS AKERA & AYUBA SUPERVISING CONSULTANT: DR OWOLABI

2. OUTLINES Introduction Definition of labour Stages of labour Evolution of partograph Strength of the partograph The WHO Labour Care Guide(LCG) Principal aim of LCG Keypoints on starting LCG Structure of the LCG Practical section

3. OUTLINES Adapting the WHO labour care guide Strategies for implementing the labour care guide Studies on use of WHO LCG Pros and cons of the WHO LCG Highlight of the W.H.O recommendations on Intrapartum care for a positive childbirth experience. Conclusion

4. THE WHO LABOUR CARE GUIDE

5. In February 2018, the WHO published a consolidated set of recommendations on intrapartum care for a positive childbirth experience. 26 new and 30 existing recommendations from onset of labour to immediate postpartum period. The recommendations are based on the principle that, through the use of effective labour and childbirth practices and avoidance of ineffective (and potentially harmful) practices, health personnel can support women to achieve their desired physical, emotional and psychological outcomes for themselves, their babies and their families. In order to facilitate effective implementation of the above recommendations, WHO reviewed and revised the design of the previous partograph. Thus, developed the labour care guide in December 2020. It is considered a women centered alternative to the existing partograph.

6. Labour Care Guide was developed to improve every woman’s experience of childbirth , and to help ensure the health and well-being of women and their babies by facilitating the effective implementation of the WHO intrapartum care recommendations . This tool establishes essential good-quality and evidence-based clinical care in all settings, and it expands the focus of labour monitoring to non-clinical practices that promote a positive childbirth experience for every woman and baby. Labour Care Guide: Why?

7. Principal aims of the WHO LCG The principal aims of the LCG are to: G uide the monitoring and documentation of the well-being of women and babies and the progress of labour. G uide skilled health personnel to offer supportive care throughout labour to ensure a positive childbirth experience for women A ssist skilled health personnel to promptly identify and address emerging labour complications, by providing reference thresholds for labour observations that are intended to trigger reflection and specific action(s) if an abnormal observation is identified. P revent unnecessary use of interventions in labour S upport audit and quality improvement of labour management.

8. For whom should the LCG be used? The LCG has been designed for the care of women and their babies during labour and childbirth. It includes assessments and observations that are essential for the care of all pregnant women , regardless of their risk status. Although the LCG was primarily designed to be used for the care of apparently healthy pregnant women and their babies. Women at high risk of developing labour complications may require additional specialized monitoring and care.

9. When should the LCG be initiated? Documentation on the LCG should be initiated for all parturient in active phase of the first stage of labour(5 cm or more cervical dilatation), irrespective of her parity and membranes status. Once initiated, the Labour Care Guide will support continuous monitoring throughout the first and second stage of active labour.

10. Where should the LCG be used? The LCG is designed for used at all levels of health care facilities. Although the plan of action will vary depending on the level of care.

11. STRUCTURE OF THE WHO LCG

12. Structure of the WHO Labour Care Guide The Labour Care Guide has 7 sections, which were adapted from the previous partograph design: Section 1: Identifying information and labour characteristics at admission Section 2: Supportive care Section 3: Care of the baby Section 4: Care of the woman Section 5: Labour progress Section 6: Medication Section 7: Shared decision-making These sections contain a list of labour observations .

13. USING THE LABOUR CARE GUIDE Once patient is admitted in active phase of labour - open the LCG chart - fill in the active phase admitting information - for all observations there is a horizontal time axis for documentation of the corresponding time of observation. - There is a vertical reference value axis for determination of any deviation from normal observation. (the alert column) The LCG also have a second stage section

14. PRACTICAL SECTION

15. ADAPTING THE LABOUR CARE GUIDE The WHO Labour Care Guide has been developed to align with WHO recommendations on intrapartum care for a positive childbirth experience . Some adaptations may be needed to reflect local conventions. Removing recommended practices from the LCG is strongly discouraged. In settings where some interventions are less feasible or not consistently available, monitoring the use of these interventions is important to help drive improvements in overall quality of care

16. STRATEGIES FOR IMPLEMENTING THE LCG A pilot study in six countries identified a number of strategies for implementing the W.H.O labour care guide. There FOUR main strategies Review and adaptation Team work in completing the LCG Leadership and training Monitoring and evaluation.

17. STUDIES ON THE USE OF THE LABOUR CARE GUIDE. An international survey of skilled health personnel on the development of the LCG involving 110 participants from 23 countries concluded that the variables were clear, relevant, appropriate and that the LCG have potential to positively impact clinical decision making and respect maternity care. Another study access the usability, acceptability and feasibility of the WHO LCG in a mixed method multi-country evaluation including Nigeria. LCG was used to monitored 1226 low risk women. Spontaneous vaginal delivery was 91.6%. Practitioner satisfaction with the LCG was high with a median usability score of 67.5%.

18. An open label RCT to determine the effect of the WHO LCG on labour outcomes especially primary caesarean section and its acceptability by healthcare providers. In the study group, CS rate was 1.5% compared to 17.8% in the control group(P- 0.0001). Duration of active phase of labour was significantly shorter in the study group that the control group (P- 0.001). Acceptability was high in the WHO LCG users.

19. PROS OF THE LCG It can be used in all health care facility It is still graphical Active phase of 5cm reduces prolonged admission and interventions. Evidence-based time limits at each centimetre of cervical dilatation Intensified monitoring in second stage Explicit recording of labour companionship, pain relief, oral fluid intake and posture Requires deviations to be highlighted and the corresponding response to be recorded by the provider.

20. CONS OF THE LCG Change may provoke anxiety among clients Antipathy among healthcare professionals-added workload. Need for training and retraining Lack of pictorial overview, hence consume more energy to interpret No care or monitoring for women in latent phase of labour Reluctant to accommodate companion of choice.

21. SUMMARY OF THE WHO RECOMMENDATIONS ON INTRAPARTUM CARE FOR A POSITIVE CHILDBIRTH EXPERIENCE

22. CONCLUSION The WHO LCG is an important tool for implementing the recommendations on intrapartum care for a positive childbirth experience. The WHO encourages local adaptation and implementation through 4 main strategies of review and adaptation, team work, leadership and training and monitoring and evaluation.

23. REFERENCES WHO. Standards for improving quality of maternal and newborn care in the health facilities. Geneva. 2016. [Accessed 30 th January 2023] WHO. WHO Labour care guide.2020. [Accessed 30 th January 2023] WHO. WHO Labour care guide user’s manual. [Accessed 30 th January 2023] WHO. WHO recommendations for intrapartum care for a positive child birth experience.2018. [Accessed 30 th January 2023] Pingray V, Bonet M, Berrueta M, Mazzoni A, Belizan M, Keil N et al. The development of the WHO Labour Care Guide: an international survey of maternity care providers. Reprod Health.2021;18:66. https://doi.org/10.1186/s12978-021-01074-2 Vogel JP, Comrie-Thomson L, Pingray V, Gadama L, Galadanci H. Usability, acceptability, and feasibility of the World Health Organization Labour Care Guide: A mixed-methods, multicountry evaluation.2022. Available from https://www.Onlinelibrary.wiley.com . [Accessed 3 rd February 2023] Divya P, Rekha B, Anjali D, Zeba K. Impact of WHO labour care guide on reducing caesarean section at a tertiary center: an open- label randomized controlled trial. AJOG Glo Reports.2022;2(3):100075.https://doi.org/10.1016/j.xagr.2022.100075  

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