WHO next‐generation partograph: revolutionary steps towards individualised labour care?

In their recent commentary, Hofmeyr et al. anticipate that departure from the familiar partograph 'may provoke anxiety and even antipathy among healthcare professionals'.1 We agree that change is urgently needed to reach beyond the coexistence of "too little, too late" and "too much, too soon" care during childbirth.2 In particular, we applaud the World Health Organization (WHO) for their underlying Better Outcomes in Labour Difficulty (BOLD) project, which has revealed the urgency of delaying the onset of the active phase of the first stage of labour from 3-4 cm of cervical dilatation to at least 5 cm.3 We do agree that the previously premature designation was 'a major iatrogenic cause of apparent poor labour progress and unnecessary interventions', which has contributed to the epidemic of caesarean sections in many countries globally.1 For the Labour Care Guide (LCG) to catalyse change, we urge the WHO to consider three major concerns, relevant for labour practice, before any further LCG implementation. World Health Organization partograph in management of labour. As the LCG stands now, the new "partograph" may work in private practice with one-to-one care, a birth companion present and pain relief available. [Extracted from the article]