Introduction to the Labor Care Guide

Definition

A monitoring tool developed by the World Health Organization (WHO), aimed at providing good quality, evidence-based, and respectful care during the intrapartum period.

It has been adopted for use in Nigeria by the Federal Ministry of Health (FMOH).

• Guide the monitoring and documentation of the well-being of women and babies, and the progress of labour
• Help skilled health personnel offer supportive care throughout labour for a positive childbirth experience
• Assist skilled health personnel to promptly identify and address emerging labour complications by providing reference thresholds for labour observations that are intended to trigger reflection and specific action(s) if an abnormal observation is identified
• Prevent unnecessary interventions in labour
• Support audit and quality improvement in labour management

The Labour Care Guide (LCG) has been designed for the care of women and their babies during labour and childbirth. It includes assessments and observations that are essential for the care of all pregnant women, regardless of their risk status.

Documentation on the LCG of the well-being of the woman and her baby, as well as the progression of labour, should be initiated when the woman enters the active phase of the first stage of labour (i.e., 5 cm or more cervical dilatation), regardless of her parity or membrane status.

For whom should the LCG be used?

All women in labour. High-risk women may require additional monitoring and care.

When should the LCG be initiated?

When women have entered the active phase of the first stage of labour (i.e., cervical dilatation of 5 cm or more).

Where should the LCG be used?

The LCG is designed for use at all levels of care in health facilities.

1. Identifying information and labour characteristics at admission
2. Supportive care
3. Care of the baby
4. Care of the woman
5. Labour progress
6. Medication
7. Shared decision-making

Time Axis (Horizontal)

Allows documentation of the time of observation.

Reference Axis (Vertical)

Contains reference values used to determine deviations from normal labour observations.

Note

• Interventions are based on observed deviations from expected norms.
• The LCG provides explicit reference thresholds for each type of observation.
• There is a section dedicated to documenting shared decisions between the healthcare provider, the woman, and her companion when care deviates from the standard.

The LCG promotes the ARCP cycle for clinical decision-making:

• A – Assess: Evaluate the woman’s and baby’s well-being and labour progress
• R – Record: Document all labour observations
• C – Check: Compare findings with the reference thresholds in the “Alert” column
• P – Plan: If any abnormal observation is identified, decide on the necessary interventions (in consultation with the woman) and document them accordingly

The "Alert" column is a critical feature of the LCG. It presents thresholds for abnormal labour observations that require further assessment and action by the healthcare provider.

How It Works:

• If labour observations do not meet any criteria in the Alert column, labour is considered to be progressing normally.
• In such cases, no medical intervention is warranted.
• If there is a deviation, it prompts the provider to reflect, assess, and possibly act, ensuring timely and appropriate care.

Observation Frequency

The frequency of observations is similar to that in the previous partograph design.

Nomenclature for Entries

• Numerical values should be recorded where applicable.
• Non-numerical observations should be recorded using a standardized set of abbreviations to maintain consistency and ensure correct interpretation of the Alert column.

Examples of LCG Abbreviations

• FHR = Fetal Heart Rate
• CTX = Contractions
• BP = Blood Pressure
• Temp = Temperature

This standardized language improves clarity and communication across care teams.

Section 1 of the LCG: Identifying Information and Labour Characteristics

This section includes key demographic and clinical admission data, such as:

• Woman’s age
• Gestational age
• Serology results (e.g., HIV, Hepatitis)
• Hemoglobin level
• Blood type and Rh factor
• Referral status and cause of referral
• Symphysis–fundal height

Section 2: Supportive Care

This section emphasizes the importance of woman-centered care and includes the following aspects:

• Labour companionship: Ensure the woman has continuous support from a chosen companion.
• Pain relief: Offer both pharmacological and non-pharmacological methods.
• Hydration: Encourage intake of oral fluids.
• Comfort measures: Support techniques that enhance the woman’s comfort and mobility during labour.

Documentation

This section should be updated hourly to reflect the care provided and the woman’s preferences.

Section 3: Care of the Baby

This section focuses on fetal well-being during labour. It includes regular assessments of:

• Fetal Heart Rate (FHR): Baseline rate and any decelerations
• Amniotic fluid: Color and consistency (e.g., clear, meconium-stained)
• Fetal position
• Moulding

Section 4: Care of the Woman

This section involves ongoing monitoring of the mother’s health, including:

• Pulse
• Blood pressure
• Temperature
• Urine: Output, protein, and acetone

Regular entries ensure that signs of maternal complications (e.g., infection, pre-eclampsia) are recognized and managed promptly.

Section 5: Labour Progress

This section involves monitoring and documenting key parameters of labour progression:

• Contractions: Frequency and duration
• Cervical dilatation: Measured through vaginal examination
• Descent of the baby’s head: Relative position in the pelvis

Goal

To assess whether labour is progressing as expected, and to determine if intervention is needed based on deviations from reference thresholds.

Section 6: Medications

This section facilitates consistent documentation of all medications and fluids administered during labour:

• Oxytocin: Indicate whether it is being used, and specify the dose and concentration
• IV Fluids: Volume and type administered
• Other Medications: Antibiotics, analgesics, antihypertensives, etc.

Section 7: Shared Decision-Making

This section is for recording communication and collaborative planning between healthcare providers, the woman, and her birth companion.

It includes:

• Continuous communication updates
• Assessment summaries
• Care plans and decisions made in response to deviations from normal
• Consent and preferences from the woman

The goal is to promote respectful maternity care and support informed, woman-centered decision-making.

Second Stage of Labour Documentation

During the second stage of labour, key findings should be documented on the right side of the LCG chart, including:

• Time of full cervical dilatation
• Frequency and strength of contractions
• Maternal vital signs
• Descent of the presenting part
• Pushing efforts and maternal cooperation
• Any interventions used
• Time of birth

Section 8: Delivery Outcome

This section facilitates documentation of events in the fourth stage of labour and the immediate postpartum period, including:

• Mode of delivery
• Condition of the newborn: Apgar score, sex, weight
• Placenta and membranes: Complete/incomplete, method of delivery
• Perineum: Intact, laceration, or episiotomy
• Estimated blood loss
• Maternal condition 1 hour post-delivery: Vital signs and uterine tone
• Immediate breastfeeding initiation (if applicable)

This provides a complete summary of the labour and delivery outcome.