WHO labour care guide: a new global standard for monitoring childbirth
FIGO has endorsed the World Health Organization’s labour care guide (LCG) as the preferred global standard for monitoring labour, calling for healthcare providers worldwide to adopt it to improve maternal and newborn outcomes.
Launched by WHO in 2020, the LCG replaces the long-standing partograph and reflects updated evidence-based practices for intrapartum care. It incorporates a more comprehensive understanding of labour progression and integrates key elements of respectful maternity care, including support for companionship, shared decision-making, and thorough monitoring during all stages of childbirth.
FIGO acknowledges that the transition from the partograph—a tool widely used since the 1970s—may generate uncertainty among healthcare providers. However, the organisation emphasises that the LCG maintains the core principles of tracking labour progress through cervical dilation and foetal descent, while offering important enhancements.
Key improvements include the introduction of an “alert” column to highlight abnormal findings, inclusion of the second stage of labour for continued monitoring, and specific attention to maternal comfort, analgesia, hydration and communication between providers and women giving birth. Clinical trials have shown that the LCG can reduce rates of caesarean section and unnecessary labour augmentation.
Despite its advantages, FIGO acknowledges that the LCG may be challenging to implement, particularly in low-resource settings, due to potentially limited awareness, inadequate training, staff shortages and lack of necessary equipment or space to support elements like continuous companionship during labour.
"The WHO labour care guide (LCG) is a transformative tool designed to enhance maternal and fetal outcomes by integrating evidence-based, respectful care during childbirth. FIGO supports its implementation as it addresses limitations of the traditional partograph, emphasises women-centered care, and promotes shared decision-making. With demonstrated feasibility and potential to reduce unnecessary interventions, the LCG fosters improved monitoring, timely interventions and respectful maternity practices. FIGO acknowledges the challenges of its adoption but remains committed to advocating for its global use to ensure safer, more positive childbirth experiences for all women and their babies.”
Dr Inês Nunes, Author and Vice-Chair of the Committee on Childbirth and PPH
Key recommendations:
- Universal adoption: Health systems should adopt the WHO LCG as the standard tool for labour monitoring to support safe, respectful, and evidence-based childbirth care.
- Training: All labour care providers must receive comprehensive training in the use of the LCG to ensure proper understanding and application.
- Facility readiness: Labour wards should be upgraded with the necessary infrastructure, equipment, and staffing to enable full implementation of the LCG.
- Respectful maternity care: Policies must support the presence of birth companions, consistent with LCG guidelines, to improve maternal experiences and outcomes.
- Monitoring and accountability: Quality improvement teams should oversee the rollout of the LCG, ensuring consistent usage through supervision, audits, and performance tracking.
- Interim use of the partograph: In settings where LCG implementation is not yet feasible, the traditional partograph should continue to be used until proper training and infrastructure are in place.