Labour Care Guide: Implementation Resource Package

What this guideline says

GMJ summary

This implementation package provides a structured seven-action approach to introduce and scale up the WHO Labour Care Guide (LCG), the successor to the WHO modified partograph. The LCG incorporates the 2018 WHO recommendations on intrapartum care for a positive childbirth experience, emphasising supportive care practices—labour companionship, mobility, birth position, oral fluids and pain relief—alongside evidence-based definitions of labour stages and timely identification of complications.

The package guides countries through a maturity model from Level 1 (awareness and adaptation) to Level 5 (continuous quality improvement). It includes tools for situational analysis, training, monitoring and routine audit, designed for use at national, sub-national and facility levels in both public and private sectors.

By implementing the LCG, health systems can reduce unnecessary interventions, promote shared decision-making with women, and improve maternal and newborn outcomes. The framework integrates intrapartum care into broader quality-of-care initiatives and routine health information systems.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. The LCG replaces the WHO modified partograph and is organised into seven sections: identification, supportive care, baby (fetal heart rate, amniotic fluid), woman (vital signs, urine), labour progress (cervical dilatation, contractions), medication, and shared decision-making.
2. Active first stage of labour is defined as cervical dilatation ≥5 cm; documentation on the LCG starts at this threshold.
3. Fetal heart rate should be monitored every 30 minutes in first stage and every 5 minutes in second stage; alert thresholds are <110 or ≥160 beats per minute.
4. Maternal vital signs: pulse alert thresholds <60 or ≥120 bpm; systolic BP <80 or ≥140 mmHg; diastolic BP ≥90 mmHg; temperature <35.0°C or ≥37.5°C, monitored every 4 hours.
5. Cervical dilatation alert thresholds: 5 cm for ≥6 hours, 6 cm for ≥5 hours, 7 cm for ≥3 hours, 8 cm for ≥2.5 hours, 9 cm for ≥2 hours.
6. Supportive care to be recorded every hour: companion present (yes/desired/no), pain relief offered, oral fluids permitted, and mobility/upright posture encouraged (not supine).
7. Implementation follows seven actions: establish leadership (LCG steering committee), conduct situational analysis, create implementation roadmap, ensure essential infrastructure, build capability through training, continuously monitor quality using routine indicators, and refine strategies for scale-up.
8. Essential equipment includes Doppler or Pinard stethoscope for fetal heart rate, BP machine, thermometer, urine dipsticks (protein ++, acetone ++), wall clock, and printed LCG forms for every birth.

Indicators for assessing LCG implementation and quality of maternal and newborn care (facility level)

Table extracted from the guideline

Source: World Health Organization, Labour Care Guide: Implementation Resource Package. Reproduced in summary form.

What changed in this edition

Versus the previous edition

• The LCG replaces the WHO modified partograph; key changes include active first stage defined at ≥5 cm (not 4 cm), expanded supportive care documentation, and structured shared decision-making section.
• New alert thresholds for cervical dilatation based on 2018 WHO intrapartum care recommendations: 5 cm for ≥6 hours, 6 cm for ≥5 hours, 7 cm for ≥3 hours, 8 cm for ≥2.5 hours, 9 cm for ≥2 hours.
• Routine supportive care practices (companion, pain relief, oral fluids, mobility) now explicitly documented every hour alongside clinical observations.

From the guideline

Verbatim

“The overall aim of LCG implementation is to improve the quality, safety, and effectiveness of maternal and newborn care during labour and childbirth, and ultimately improve health outcomes for women and their babies.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

Related on GMJ

Interconnected resources

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