Impact of the WHO Labour Care Guide on Maternal Birth Satisfaction: A Longitudinal Study Protocol

ARTICLE TYPE  Research Protocol

Recommended tags: FCPS, WHO Labour Care Guide, Maternal Birth Satisfaction, Labour Monitoring, Childbirth, Birth Satisfaction Scale-Revised, Labour Outcomes

Abstract

Background: The World Health Organization (WHO) Labour Care Guide (LCG) was introduced as an evidence-informed, woman-centred approach to monitoring labour and supporting clinical decision-making. Maternal experience and satisfaction are important dimensions of quality intrapartum care, alongside clinical outcomes.

Objective: To assess the impact of the WHO Labour Care Guide on maternal birth satisfaction and to describe selected labour outcomes.

Methods: This protocol describes a longitudinal study with a planned sample of 165 women recruited through non-probability consecutive sampling over six months following approval. Eligible participants will be 18–40 years old, have parity below five, be at term gestation (37+0 to 41+6 weeks), and present with spontaneous onset of labour. Data will include demographic and obstetric characteristics, duration of the first stage of labour, operative vaginal delivery, and maternal birth satisfaction.

Outcomes and analysis: The primary outcome is maternal birth satisfaction assessed after childbirth using the Birth Satisfaction Scale-Revised (BSS-R), as specified in the synopsis. Prolonged first-stage labour and operative vaginal delivery are additional outcomes. Data are planned to be analysed in SPSS version 25 using descriptive statistics, stratification for relevant effect modifiers, and chi-square testing, with p < 0.05 considered statistically significant.

Conclusion: The study is intended to generate context-specific evidence about maternal satisfaction and selected labour outcomes associated with use of the WHO Labour Care Guide. As this is a protocol, no study findings are reported.

Keywords

World Health Organization Labour Care Guide; maternal birth satisfaction; labour monitoring; childbirth; Birth Satisfaction Scale-Revised; longitudinal study; obstetrics.

1. Introduction

Quality intrapartum care requires careful monitoring of labour progression, timely clinical decisions, and respectful, woman-centred communication. Increasing attention to caesarean delivery rates and their potential implications for maternal and neonatal health has encouraged the evaluation of labour-monitoring approaches that support appropriate, evidence-informed care [2, 4].

Traditional labour monitoring has often relied on the partograph. Questions about applying a fixed cervical-dilatation threshold to every woman have prompted efforts to better recognise normal variation in labour progression. In 2020, the WHO introduced the Labour Care Guide as an updated tool intended to support structured, evidence-informed monitoring and person-centred care during labour [5, 7].

Published work has examined the WHO Labour Care Guide and related labour-monitoring approaches in relation to maternal and neonatal outcomes, clinical interventions, and implementation in care settings [3, 6, 8]. Maternal birth satisfaction is also an important outcome because it captures a woman’s experience of care rather than clinical events alone.

This study is planned to assess maternal birth satisfaction following use of the WHO Labour Care Guide and to document selected labour outcomes. The findings may help inform local discussions about intrapartum-care quality and the practical use of structured labour monitoring.

2. Objective

To determine the outcome of the WHO Labour Care Guide on maternal birth satisfaction.

3. Hypothesis

Women managed using the WHO Labour Care Guide will have significantly higher maternal birth satisfaction than women managed using standard labour-monitoring practices.

4. Materials and Methods

4.1 Study design

Longitudinal study.

4.2 Setting and duration

The study is planned in an obstetric care setting. The study duration will be six months after approval of the synopsis by the relevant ethics and administrative review bodies.

4.3 Sample size and sampling technique

The planned sample size is 165 participants. According to the source synopsis, this was calculated using a WHO sample-size calculator with a 95% confidence level, a 3% margin of error, and an estimated operative vaginal delivery proportion of 4% with the WHO Labour Care Guide. Participants will be recruited using non-probability consecutive sampling.

4.4 Inclusion criteria

·         Women aged 18–40 years.

·         Parity below five.

·         Term gestation between 37+0 and 41+6 weeks.

·         Spontaneous onset of labour, assessed clinically.

4.5 Exclusion criteria

·         Multiple pregnancy or non-cephalic presentation confirmed by ultrasound.

·         Pregnancy conceived through in-vitro fertilisation.

·         Chronic or gestational hypertension, diabetes, obstetric complications, a previous caesarean section, or any other contraindication to vaginal delivery, as documented in the clinical record.

4.6 Study procedure and data collection

Following approval from the relevant ethics review body, eligible women will be approached for enrolment and informed consent. Baseline information will include age, gestational age, parity, body mass index, labour duration, lifestyle, socioeconomic category, and booking status. Socioeconomic categories in the source synopsis are defined as low income below PKR 25,000 per month, middle income PKR 25,000–50,000, and high income above PKR 50,000 per month. Participants will be managed using the WHO Labour Care Guide as described in the synopsis and followed during labour and after birth. The duration of the first stage of labour, any operative vaginal delivery, and maternal satisfaction will be recorded on a structured proforma.

4.7 Operational definitions and study outcomes

·         WHO Labour Care Guide: Use of the WHO Labour Care Guide will be recorded for women presenting in active labour, according to the study proforma.

·         Prolonged first stage of labour: Defined in the synopsis as a first stage lasting more than six hours from the onset of active labour.

·         Operative vaginal delivery: A vaginal birth requiring instruments such as forceps or a vacuum extractor to assist delivery during the second stage of labour.

·         Maternal birth satisfaction: The synopsis identifies maternal birth satisfaction as the primary outcome and specifies assessment after childbirth using the Birth Satisfaction Scale-Revised (BSS-R). It also describes satisfaction operationally as the woman being satisfied with the method and agreeing to adopt it again.

4.8 Statistical analysis

Data will be entered and analysed using SPSS version 25. Maternal age, parity, gestational age, body mass index, and duration of the first stage of labour will be summarised using means and standard deviations. Lifestyle, socioeconomic status, booking status, and study outcomes will be reported as frequencies and percentages. Potential effect modifiers—including maternal age, parity, gestational age, body mass index, lifestyle, socioeconomic status, and booking status—will be addressed through stratification. Outcomes across strata will be compared using the chi-square test. A p-value below 0.05 will be considered statistically significant.

4.9 Ethical considerations

Ethical review approval and informed consent will be obtained before participant enrolment. Personal and clinical information should be handled confidentially and reported in aggregate form.

5. Primary Outcome and Expected Utilisation

The primary outcome is maternal birth satisfaction assessed after childbirth using the BSS-R. Additional outcomes include prolonged first-stage labour and operative vaginal delivery. The planned findings may help evaluate the usefulness of the WHO Labour Care Guide in routine obstetric practice, support respectful maternity care, inform local service policies, and identify priorities for future research. These are anticipated uses of the study; they are not reported findings.

6. Proposed Six-Month Schedule

7. References

1.       World Health Organization. Trends in maternal mortality: 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. 2023.

2.       Asadi A, Agheli L, Assari Arani A, Naseri A. Identifying and analyzing the economic, social and cultural factors affecting the rate of cesarean in Tehran. Iran J Health Insur. 2020;2(4):184–197.

3.       Ebrahimian A, Iravani M, Siahkal SF. Effects of World Health Organization labour care guide on maternal and neonatal outcomes: a systematic review and meta-analysis. Int J Reprod BioMed. 2025;23(9):689–700.

4.       Hossain MS, Shuvo SD, Asha S, Chodhoury MR, Elahi MT. Cesarean delivery and its determining factors: a hospital-based study in Jashore District, Bangladesh. Public Health Pract. 2024;8:100558.

References (continued)

5.       World Health Organization. WHO Labour Care Guide: User’s Manual. Geneva: World Health Organization; 2020.

6.       Vogel JP, Pingray V, Althabe F, Gibbons L, Berrueta M, Pujar Y, et al. Implementing the WHO Labour Care Guide to reduce the use of caesarean section in four hospitals in India: protocol and statistical analysis plan for a pragmatic, stepped-wedge, cluster-randomized pilot trial. Reprod Health. 2023;20(1):18.

7.       Ghulaxe Y, Tayade S, Huse S, Chavada J. Advancement in partograph: WHO’s Labour Care Guide. Cureus. 2022;14(10).

8.       Manisha M, Chanania K. Impact of the WHO Labour Care Guide on maternal outcomes in low-risk pregnant women: a comparison with WHO modified partograph. Biomed Biopharma Res. 2025;22(2):878–887.