3. APPROPRIATE CENTRES FOR OPERATIONS RESEARCH

The partograph can be used by any person trained in midwifery who can perform accurate vaginal examinations to assess cervical dilatation in labour and then accurately plot that dilatation on the partograph. It can therefore be used by specialist obstetricians, general medical officers, nurses, midwives, or medical assistants or nurse aides with training in midwifery. It can be used in health centres or hospitals, but cannot be used by birth attendants who cannot perform vaginal examinations or plot the course of labour graphically.

It is recommended that health centres wishing to undertake operations research on the partograph have a minimum of 500 deliveries per year. At least 1000 deliveries are likely to be necessary to accumulate meaningful results and the research should not be undertaken over a period longer than 2 years. However, smaller health centres performing fewer deliveries are encouraged to participate and their results may be pooled. For example, five health centres, each conducting 200 deliveries per year, might feed referrals into a district hospital conducting 1000 deliveries per year. Under these circumstances, the partograph is probably best introduced into the hospital first and then its use expanded to health centre level. This is described in more detail under “Methodology”.

Operations research conducted in the situation described above is particularly encouraged, because information on the value of the partograph in making decisions about transferring labouring women is particularly lacking. However, any centre wishing to introduce the partograph is encouraged to do so, adapting it as they feel appropriate to their local needs.

This WHO series on the use of the partograph offers guidelines on the management of labour once the action line on the partograph is reached or crossed, in the User’s Manual and in The application of the WHO partograph in the management of labour. Report of a WHO multicentre study 1990-1991 (WHO/FHE/MSM/94.4). If managed appropriately, by this point all such cases should be in a hospital with expertise and facilities available to augment labour and/or conduct caesarean section. Precise management will vary from place to place, and research into various possible lines of management can, of course, be carried out in conjunction with that described in this protocol.