The journey of childbirth, while a natural process, carries inherent risks that require careful, evidence-based monitoring to ensure the safety of both mother and baby. In Zambia, like many other countries, improving maternal and perinatal health outcomes remains a critical public health priority. To address this, Zambia recently embarked on a pioneering project: the pilot implementation of the World Health Organisation’s Labour Care Guide (LCG).

This pilot, spearheaded by the Zambia Association of Gynaecologists and Obstetricians (ZAGO) – was conducted in six (6) selected healthcare facilities across the high-volume Lusaka and Copperbelt provinces, and six control sites. The aim of the pilot is to move beyond traditional partograph use and introduce a more comprehensive, woman-centred approach to labour monitoring. Implementation facilities included, Ndola Teaching Hospital, Roan Antelope General Hospital, Ronald Ross General Hospital, on the Copperbelt; and Levy Mwanawasa Teaching Hospital, Kafue General Hospital, and Chilenje Level One Hospital in Lusaka province. Control sites included Kitwe Teaching Hospital, Chifubu Level One Hospital, and Nchanga North General Hospital on the Copperbelt, while Lusaka Province had University Teaching Hospital (Women and Newborn), Chipata Level One Hospital, and Chongwe District Hospital.

The goal was to assess the adaptation, implementation process, and the potential effectiveness of the LCG in a real Zambian context.

The LCG is not merely a revised partograph; it is a paradigm shift. Developed by the WHO based on its 2018 intrapartum care recommendations, the LCG reimagines labour monitoring as a holistic, dynamic process. It replaces the older “alert-action” line model with a broader framework that emphasizes:

• Woman-Centred Care: The woman as an active participant in childbirth. Her emotional, psychological, and physical well-being (e.g., comfort, mobility, support) are continuously assessed alongside clinical findings.
• Comprehensive Monitoring: It integrates the “Fetal Well-being,” “Labour Progress,” and “Maternal Well-being” on a single page, ensuring all critical aspects are reviewed together.
• Clinical Decision Support: It provides clear, colour-coded prompts (green, yellow, red) to guide healthcare providers in making timely decisions, encouraging early problem identification and intervention.
• Team Communication: It is designed as a communication tool for the entire maternity team, promoting clarity and continuity of care during shift changes.

Facilities were equipped with the LCG tools and their staff underwent targeted training. The focus was on building competency in interpreting the guide’s prompts in order to foster a more interactive relationship with the labouring woman, and improving interdisciplinary communication.

While full evaluation data has been analysed and results disseminated across stakeholders including the Ministry of Health and WHO, the pilot aimed to impact several critical outcome areas:

1. Improved detection of complications by ensuring eearly identification of labour dystocia, foetal distress, and maternal hypertension or sepsis.
2. Reduced unnecessary interventions by distinguishing normal from abnormal labour patterns so as to reduce of unnecessary oxytocin augmentation or cesarean sections.
3. Enhanced woman’s experience and value maternal comfort and autonomy, the approach promotes dignity and respect during childbirth.
4. Strengthened healthcare systems aimed at providing insights into training needs, supply chains for printed tools, and supervision models required for national scale-up.

The success of this pilot isnot just in the findings, but in how the lessons learned inform policy. The four-month pilot implementation on usability, adherence, and clinical outcomes are invaluable for the Ministry of Health and partners in deciding on the potential nationwide rollout of the LCG.

ZAGO’s pilot of the WHO Labour Care Guide represents a significant step forward in the quest for safer childbirth. The association tested this innovative, holistic model of care – paving way for the country to invest in a future where every labouring woman receives attentive, personalised, and evidence-based monitoring. The pilot aligned squarely with Sustainable Development Goals and Zambia’s own commitment to reducing maternal and newborn mortality. The journey from pilot to practice requires dedication, but it holds the promise of transforming the standard of intrapartum care for generations of Zambian mothers and their babies.