Prolonged labor can cause maternal dehydration, exhaustion, sepsis, fistula, and hemorrhage in mothers while also endangering the fetus. Whether caused by insufficient uterine contractions or the fetus is too large to pass through the pelvis, this condition endangers mothers and infants especially when there isn't skilled care available to know when and how to intervene.
Mechanism of Action
Partographs graphically represent the progression of labor. They show when labor is proceeding at a normal rate and when care providers should begin preparing for and carrying out interventions. Some women will need interventions to help deliver the baby and some will even need C-section to remove the baby surgically.
Most partographs consist of three sections: the fetal record, the labor record, and the maternal record. The fetal record may track fetal heart rate, amniotic liquor, and moulding of the fetal skull. The labor record tracks cervical dilatation and descent of the fetus’ head over time, comparing it to a pre-printed “alert” and “action” lines. The maternal record often captures contractions, blood pressure, pulse, urine output, temperature, and drugs administered--including drugs to help the uterus contract. These sets of information keep a record of the birth process and indicate when further interventions are necessary.
Current Use in High-Resource Settings
Partographs gained popularity in the 1970’s and today most labor and delivery wards use them. A large and growing body of literature shows that their correct use lowers rates of prolonged labors and associated complications. It has also been suggested that the use of the partograph results in fewer surgical interventions such as Caesarean sections. Electronic partographs are becoming more widespread and can be built into medical records systems.
Application in Low-Resource Settings
The use of partographs is most common in hospitals (rather than clinics or homes) in low-resource settings. Beyond hospitals, a study of health extension workers and midwives in peripheral delivery units in Nigeria found that only 10% of caregivers consistently used the partograph, and even fewer used it correctly. Correct use may be limited by training, time, and caregiver skill level. In many cases, literacy and numeracy are barriers to broader use. Finally, the partograph requires the ability to intervene to help when normal labor is insufficient. This intervention may include delivery aids and training for the birth attendant or transport to a hospital where proceedures such as C-section can take place.