Exploring potential opportunities and strategies of using the Labour Care Guide to improve labour monitoring and health outcomes among health care providers in Uganda: a qualitative study

Abstract

Background: Labour monitoring tracks cervical dilation, contractions, and foetal heart rate to ensure safe childbirth. Prolonged labour is identified when progress exceeds expected timelines, shown on the partograph or Labour Care Guide (LCG). The LCG helps health care providers detect abnormal labour patterns early. This study explored how the LCG could enhance labour monitoring in Uganda, identifying strategies to improve maternal and foetal outcomes through timely assessments and interventions. Methods: Between June and September 2023, qualitative interviews were held with Health Care Providers and Ministry of Health officials familiar with the Labour Care Guide. Conducted privately and digitally recorded, the interviews were transcribed and coded. Through iterative analysis, researchers identified multilevel factors influencing sustained engagement in labour monitoring and the uptake and implementation of the LCG. Results: The median age of the interviewed HCPs was 36 years(IQR,27-54). All participants demonstrated great enthusiasm, describing the LCG as a simple, easy-to-use and comprehensive tool that could quickly aid detection of prolonged labour for timely management, if modified appropriately. HCPs identified LCG’s potential to facilitate sustained use through perceived ability to correctly define active labour at 5 cm of cervical dilatation, with major labour parameters recorded on one-A4-paper for easy comparison and reference. LCG facilitated HCP-patient labour companion interaction for social support and would undergo customization to address user needs, enhance accountability and reduce over-documentation since the same single-page format could capture all the necessary details needed to make a one-stop quick and effective clinical decision. HCPs underscored the role and sustained benefits of off-site training, team building, guidelines accessibility, real-time feedback, peer mentorships and championships. LCG pitfalls included small fonts, observation ordering, missing record of social-demographic and key outcome data, plus fields/parameters deemed redundant/inappropriate. Conclusion: Our data demonstrates a responsive, enthusiastic and supportive environment that has potential to facilitate LCG customization, uptake and scale up. The high LCG expectations are important considerations in developing sustainable and acceptable implementation strategies that meet user needs. More work is needed to refine and evaluate the tool’s effectiveness in improving labour monitoring in Uganda.