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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2017

Open Access 01-12-2017 | Research article

Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants’ perceptions

Authors: Nanna Maaløe, Natasha Housseine, Jos van Roosmalen, Ib Christian Bygbjerg, Britt Pinkowski Tersbøl, Rashid Saleh Khamis, Birgitte Bruun Nielsen, Tarek Meguid

Published in: BMC Pregnancy and Childbirth | Issue 1/2017

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Abstract

Background

While international guidelines for intrapartum care appear to have increased rapidly since 2000, literature suggests that it has only in few instances been matched with reviews of local modifications, use, and impact at the targeted low resource facilities. At a Tanzanian referral hospital, this paper describes the development process of locally achievable, partograph-associated, and peer-reviewed labour management guidelines, and it presents an assessment of professional birth attendants’ perceptions.

Methods

Part 1: Modification of evidence-based international guidelines through repeated evaluation cycles by local staff and seven external specialists in midwifery/obstetrics. Part 2: Questionnaire evaluation 12 months post-implementation of perceptions and use among professional birth attendants.

Results

Part 1: After the development process, including three rounds of evaluation by staff and two external peer-review cycles, there were no major concerns with the guidelines internally nor externally. Thereby, international recommendations were condensed to the eight-paged ‘PartoMa guidelines ©’. This pocket booklet includes routine assessments, supportive care, and management of common abnormalities in foetal heart rate, labour progress, and maternal condition. It uses colour codes indicating urgency. Compared to international guidelines, reductions were made in frequency of assessments, information load, and ambiguity. Part 2: Response rate of 84% (n = 84). The majority of staff (93%) agreed that the guidelines helped to improve care. They found the guidelines achievable (89%), and the graphics worked well (90%). Doctors more often than nurse-midwives (89% versus 74%) responded to use the guidelines daily.

Conclusions

The PartoMa guidelines ensure readily available, locally achievable, and acceptable support for intrapartum surveillance, triage, and management. This is a crucial example of adapting evidence-based international recommendations to local reality.

Trial registration

This paper describes the intervention of the PartoMa trial, which is registered on ClinicalTrials.org (NCT02318420, 4th November 2014).
Appendix
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Metadata
Title
Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants’ perceptions
Authors
Nanna Maaløe
Natasha Housseine
Jos van Roosmalen
Ib Christian Bygbjerg
Britt Pinkowski Tersbøl
Rashid Saleh Khamis
Birgitte Bruun Nielsen
Tarek Meguid
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2017
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-017-1360-2

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