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Introduction The World Health Organization’s (WHO) Labour Care Guide (LCG) is a “next‐generation” partograph based on WHO’s latest intrapartum care recommendations. It aims to optimize clinical care provided to women and their experience of care. We evaluated the LCG’s usability, feasibility, and acceptability among maternity care practitioners in clinical settings. Methods Mixed‐methods evaluation with doctors, midwives, and nurses in 12 health facilities across Argentina, India, Kenya, Malawi, Nigeria, and Tanzania. Purposively sampled and trained practitioners applied the LCG in low‐risk women during labor and rated experiences, satisfaction, and usability. Practitioners were invited to focus group discussions (FGDs) to share experiences and perceptions of the LCG, which were subjected to framework analysis. Results One hundred and thirty‐six practitioners applied the LCG in managing labor and birth of 1,226 low‐risk women. The majority of women had a spontaneous vaginal birth (91.6%); two cases of intrapartum stillbirths (1.63 per 1000 births) occurred. Practitioner satisfaction with the LCG was high, and median usability score was 67.5%. Practitioners described the LCG as supporting precise and meticulous monitoring during labor, encouraging critical thinking in labor management, and improving the provision of woman‐centered care. Conclusions The LCG is feasible and acceptable to use across different clinical settings and can promote woman‐centered care, though some design improvements would benefit usability. Implementing the LCG needs to be accompanied by training and supportive supervision, and strategies to promote an enabling environment (including updated policies on supportive care interventions, and ensuring essential equipment is available).

To assess whether the implementation of a package of activities through the joint action of three international healthcare professional associations (HCPAs) increased the use of essential interventions (EIs) for delivery and neonatal care.A noncontrolled pre-intervention versus post-intervention study was conducted from June 13 to December 13, 2016, among women older than 18 years of age, who had delivered at one of two urban tertiary hospitals in Nepal.The study included 9252 women. Minimal change was found after the implementation of EIs that were used frequently at baseline (e.g. social support during delivery in the emergency room, and promotion and support for early initiation of breastfeeding). By contrast, an increase was recorded for some EIs that had not been used regularly at baseline. For example, the rate of timely administration of prophylactic antibiotics before cesarean delivery increased from 0.0% (0/496) to 94.0% (409/435) at one hospital. Nonetheless, some EIs with low use at baseline did not show improvement after implementation (e.g. kangaroo mother care).The present study strengthened previous findings regarding the uptake of EIs following joint promotion by HCPAs in low-income settings.

Objective To assess whether the implementation of a package of activities through the joint action of the three international healthcare professionals associations (HCPAs) increased the use of intrapartum and postnatal essential interventions (EIs) in two hospitals in Uganda. Methods A non-controlled before-and-after study was undertaken to evaluate the effect of a package of activities designed to change practice relating to nine EIs among providers. Coverage of the EIs was measured in a 3-month pre-implementation period and a 3-month post-implementation period in 2014. Data were obtained for women older than 18 years who delivered vaginally or by cesarean. Results: Overall, 4816 women were included. Level of use remained high for EIs used widely at baseline. Some EIs that had low use at baseline did not show improvement after the implementation. Promotion of breastfeeding showed a significant improvement in the Kampala hospital, from 8.5% (8/94) to 25.6% (30/117; P=0.001), whereas promotion of hygiene in cord care improved at the Mbarara hospital, from 0.1% (2/1592) to 46.0% (622/1351; P

Argentina and Uruguay are among the countries with the highest proportion of pregnant women who smoke, showing a prevalence of near 20%. The implementation of an effective smoking cessation intervention would have a significant impact on the health of mothers and children. The “5 A’s” (Ask, Advise, Assess, Assist, Arrange) is a strategy consisting of a brief cessation counseling session of 5–15 minutes delivered by a trained provider, which is considered the standard of care worldwide. However, less than 10% of pregnant women who smoke receive this intervention during antenatal care in Argentina and Uruguay. We will design a multifaceted intervention to implement the “5 A’s” strategy. Midwife facilitators working in antenatal care facilities will be identified and trained to deliver the “5 A’s” to pregnant women and will then disseminate and implement the program. The intervention will be tailored by formative research to be readily applicable to local antenatal care services, as well as to be acceptable to local pregnant women and health providers. To evaluate the effectiveness of this intervention we will conduct a two-arm, parallel cluster randomized controlled trial in 20 antenatal care facilities in Argentina and Uruguay. Our primary hypothesis is that the intervention is feasible in antenatal care facilities in both countries and will increase the frequency of women receiving tobacco use cessation counseling during pregnancy. Our secondary hypothesis is that the intervention will decrease the frequency of women who smoke by the end of their pregnancies. Antenatal care facilities (in health centers or hospitals) will be randomly allocated to either an intervention or a control group after a baseline data collection period. The 10 facilities in the control group will continue with their standard in-service activities. A follow-up data collection will be conducted immediately after delivery. The study will be conducted in 48 months.