Establishing standards for obstructed labour in a low-income country.

INTRODUCTION Conventionally standards for maternity care are developed by a panel of experts (usually obstetricians) and then implemented by a multidisciplinary team. The present study concerns the feasibility of involving health professionals of all grades in the establishment standards for obstructed labour in Malawi. METHODS Standards for obstructed labour were developed by a multidisciplinary team involving all cadres of health professionals working in maternity units, as well as hospital managers and policy makers, using evidence from Malawi national guidelines, World Health Organisation manuals and peer-reviewed journals. Each standard consisted of a clear objective with structure, process and outcome criteria. RESULTS Seven objectives were agreed, and structure, process and outcome criteria were developed for each objective. The standards addressed different aspects of the management of obstructed labour, namely early recognition of prolonged labour by labouring women and traditional birth attendants, early arrival of women to health facilities during labour, proper use of partograph by healthcare providers, proper management of prolonged labour, proper management of obstructed labour, appropriate management of uterine rupture and early delivery of the baby. CONCLUSION It is feasible to develop standards of emergency obstetric care in low-income countries using a multidisciplinary team that involves health professionals of all grades. The involvement of all health professionals might promote successful implementation, ownership and sustainability. The involvement of hospital managers and policy makers in the early stages of criteria-based audit might promote support from the hierarchy with regards to the allocation of resources.