|Preventing Prolonged Labour I (WHO - OMS, 1994, 22 p.)|
The implementation of the partograph implies a functioning referral system with essential obstetric functions in place. Its use should also improve the efficiency and effectiveness of maternity services.
The proposed partograph and its accompanying management guidelines can only be used where the woman presents herself to the formal health care system in labour and where staff who fulfil certain minimum training criteria work. These staff must:
· Have adequate training in midwifery to observe and conduct normal labour and delivery.
· Be able to perform vaginal examinations in labour and accurately assess cervical dilatation.
· Be able to plot cervical dilatation accurately on a graph against time.
There is evidence (10, 36) that midwife-auxiliaries with quite basic training are able to fulfil these functions and it should therefore be possible to introduce the partograph into a peripheral level of formal health care (10, 24). In these circumstances, the critical function of the partograph is to indicate when referral is appropriate.
It is, however, essential that the introduction of the partograph be combined with a programme of training in its use and of close supervision, encouragement and follow-up of those using it.