Knowledge of Private Hospital Midwives on the Use of the Partogram

Background: The partogram is a clinical practice guideline that is useful in early detection of complications during labour, but is still poorly completed. Midwives are failing to monitor and plot the maternal and foetal status correctly during the latent and active phase of labour. Quality-of care audits in South Africa also identified incorrect interpretation of the partogram. Partogram use varies between different health care facilities due to internal training facilities in the workplace. No studies on the knowledge of midwives on partogram use in the private sector could be found.

Objective: The aim of the study was to explore the knowledge of midwives working in a private maternity hospital regarding the use of the partogram.

Design: The study used an explanatory mixed method design. In-depth interviews with midwives and advance midwives followed quantitative questionnaires. The questionnaire consisted of eight questions and an open-ended question to obtain baseline data, clarify the knowledge of the midwives on the use of the partogram and their perceptions on the use of the partogram during decision making. The interviews explored the knowledge of the midwives on the Guidelines for Maternal Care and partogram use as well as their responsibilities regarding the use of the partogram in clinical practice. Thematical analysis was used to analyse the data of the interviews. 

Setting: A private maternity hospital in Gauteng Province, South Africa was used.

Participants: Eleven midwives and three advanced midwives of the seventeen midwives working in the labour unit of the private maternity hospital participated in the study.

Findings: Although all the midwives and advanced midwives new the purpose of the partogram, where to find the recommendations on the use of the partogram and the signs of true labour, not all were sure when the partogram had to be completed and who remains responsible to plot the findings. Fetal heart rate monitoring during the active phase of labour remains a concern.

Key conclusion: The midwives understood the importance of the partogram but were not using the tool to the extent it is intended.

Implications for practice: The study identified key knowledge areas of midwives working in a private hospital on partogram use that need further regular updates through internal workshops. Training and re-training of midwives could ensure proper understanding of the partogram as a tool to monitor and manage labour.