Why did not midwives use partograph correctly?

Background. WHO has developed the concept of partograph and recommended it as auxiliary tool to monitor progress of first stage of labour, detect complicating factors, and help midwives in decision making. Though various studies have proven the beneficial use of partograph, application of birth progress monitoring is not done properly. Aim: To observe midwives' obedience in using partograph and explore the obstacles. Method. The study used mixed methods with sequential explanatory strategy. Quantitative study used cross-sectional design with observational method. Qualitative study used phenomenological approach through thorough interviews. Data collecting was done in November 2014 to March 2015 in health facilities in Bandung City, Bandung and Sukabumi Regency. 53 midwives were observed and 27 involved in thorough interviews. Result. Observation showed 60.4% of midwives used partograph incompletely. Midwives had obstacles in using partograph properly. Knowledge was not main factor causing inobedience. Other contributing factors were skills, training, time with midwife-patient ratio, work burden, formality, supporting system, application of discipline/sanction, attitude. Conclusion. Partograph cannot be used as a manual, single auxiliary tool in monitoring birth progress. Government needs to re-evaluate the policy of partograph usage.