Knowledge and Attitudes toward the Utilization of Partograph among Midwives

1.1 Introduction

The partograph is a graphical clinical tool used to systematically record and monitor the progress of labour, maternal condition, and fetal wellbeing over time. It provides a visual representation of cervical dilatation, uterine contractions, fetal heart rate, and other vital parameters, enabling timely identification of deviations from normal labour and supporting prompt clinical decision-making (World Health Organization [WHO], 2018). As a low-cost and effective instrument, the partograph is widely recommended for routine use in all labour settings, particularly in resource-limited environments where advanced monitoring technologies may not be readily available.

Globally, maternal and neonatal morbidity and mortality remain significant public health concerns, with a disproportionate burden borne by low- and middle-income countries. Prolonged and obstructed labour are among the leading contributors to preventable maternal deaths and adverse birth outcomes. The appropriate use of the partograph has been shown to reduce the incidence of these complications by promoting early detection of abnormal labour patterns and facilitating timely referral or intervention (Lavender, Hart, & Smyth, 2013).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.

1.2 Background of Study

The partograph is widely recognized as an essential tool for monitoring labour and improving maternal and neonatal outcomes. According to the World Health Organization (WHO), the partograph provides a standardized and systematic approach to observing labour progress, fetal condition, and maternal wellbeing, thereby supporting early identification of abnormal labour and timely clinical intervention (WHO, 2018). Its introduction into maternity care was intended to reduce complications associated with prolonged and obstructed labour, which remain major contributors to maternal and neonatal morbidity and mortality in developing countries.

Several scholars have emphasized the significance of the partograph in intrapartum care. Lavender, Hart, and Smyth (2013) reported that consistent use of the partograph is associated with improved labour management and reduced rates of unnecessary interventions. Similarly, Friedman (2008) asserted that graphical representation of labour progress enhances clinical judgment and facilitates prompt decision-making during childbirth. These perspectives reinforce the relevance of the partograph as a practical and effective tool in maternity settings.

Midwives are central to the utilization of the partograph, particularly in hospital environments where they provide continuous care to women in labour. Opiah et al. (2012) stated that the knowledge and attitude of midwives directly influence whether the partograph is properly completed and used as intended. When midwives understand the components and significance of the partograph, they are more likely to apply it correctly and consistently. Conversely, inadequate knowledge or unfavorable attitudes may result in poor documentation or complete non-use of the tool.

Studies conducted in different regions of Africa highlight ongoing challenges in partograph utilization. Yisma et al. (2013) affirmed that although many obstetric care providers are aware of the partograph, gaps exist between knowledge and actual practice due to factors such as workload, staff shortages, and limited supervision. On the other hand, Fawole et al. (2010) contended that negative perceptions of the partograph, including the belief that it is time-consuming or unnecessary for normal labour, contribute significantly to its underutilization in health facilities.

In the Nigerian context, maternal mortality remains a critical public health issue, and effective labour monitoring is a key strategy for addressing this challenge. According to National health reports, prolonged labour and delayed referral continue to account for a substantial proportion of preventable maternal deaths. Adegoke, Lawoyin, and Ogundipe (2011) reported that poor utilization of evidence-based tools such as the partograph undermines the quality of intrapartum care provided to women in labour. At the Federal Medical Centre, Asaba, Delta State, midwives are responsible for a large proportion of labour monitoring and delivery services. This study is set against the backdrop of persistent concerns about maternal health outcomes and the need for effective utilization of proven clinical tools in labour management.

1.3 Statement of Problems

Investigation revealed that the partograph is a simple, cost-effective clinical tool designed to monitor the progress of labour and the wellbeing of both mother and fetus. Its proper utilization is widely recognized as a key strategy for the early detection of abnormal labour, timely decision-making, and reduction of preventable maternal and neonatal complications (WHO, 2018). In many tertiary and secondary health facilities, midwives are the primary professionals responsible for labour monitoring and documentation. Their level of knowledge and attitude toward the partograph strongly influences whether it is correctly and consistently used during labour management (Yisma et al., 2013; Opiah et al., 2012).

Furthermore, some midwives may possess theoretical knowledge of the partograph but fail to translate this knowledge into practice due to institutional constraints such as inadequate staffing, poor supervision, or absence of clear hospital policies supporting its routine use. At the Federal Medical Centre, Asaba, where a significant number of deliveries are conducted daily, the extent to which midwives understand, perceive, and utilize the partograph has not been adequately documented. It is against this backdrop that this study seeks to assess the knowledge and attitudes toward the utilization of the partograph among midwives at the Federal Medical Centre, Asaba, Delta State.

1.4 Aim and Objectives of Study

The aim of the study is to assess the knowledge and attitudes of midwives regarding the utilization of the partograph and their effect on intrapartum care at the Federal Medical Centre, Asaba. In achieving this aim, the following specific objectives were laid out as follows:

1. To determine the level of knowledge of midwives regarding the components and use of the partograph.
2. To examine the attitudes of midwives toward the utilization of the partograph in labour monitoring.
3. To identify the factors that influence proper utilization of the partograph among midwives.
4. To assess the relationship between knowledge, attitudes, and the actual use of the partograph in clinical practice.

1.5 Research Questions

Based on the stated objectives, the study will seek to answer the following questions:

• What is the level of knowledge of midwives regarding the partograph?
• What are the prevailing attitudes of midwives toward the utilization of the partograph?
• What factors influence midwives' proper utilization of the partograph during labour?
• Is there a relationship between midwives' knowledge and attitudes and their practical use of the partograph?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

• H₀1: There is no significant relationship between midwives' knowledge and their utilization of the partograph.
• H₀2: There is no significant relationship between midwives' attitudes and their utilization of the partograph.

1.7 Significance of Study

It is believed that at the completion of the study, the findings will support the allocation of resources toward continuous professional development and the reinforcement of evidence-based obstetric practices. In addition, the research will provide data to inform policies, supervision, and resource allocation that will strengthen partograph utilization.

Furthermore, the study will generate evidence that will inform maternal health strategies aimed at reducing preventable maternal and neonatal deaths. It will also help identify areas where midwives' skills and knowledge can be enhanced, ultimately improving labour monitoring and patient outcomes.

Lastly, this research will add to existing academic literature on partograph utilization and midwifery practice in Nigeria. It will serve as a reference for future researchers and students who will wish to conduct further studies on labour monitoring, maternal health tools, and factors influencing their effective use in clinical settings.

1.8 Scope of Study

The scope of the research is focused on the knowledge and attitudes toward the utilization of partograph among midwives, using Federal Medical Centre, Asaba, Delta State as a case study. The study is limited to midwives currently engaged in obstetric care within this facility.

1.9 Limitations of the Study

During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
3. Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.

1.10 Definition of Terms

Partograph: A graphical tool used by midwives and obstetric care providers to monitor labour progression, maternal condition, and fetal wellbeing over time (WHO, 2018).

Knowledge: The awareness, understanding, and information midwives possess regarding the partograph, including its components and proper use (Opiah et al., 2012).

Attitude: The feelings, perceptions, and disposition of midwives toward using the partograph in routine labour management (Yisma et al., 2013).

Utilization: The practical application and consistent use of the partograph by midwives during labour monitoring to guide clinical decisions (Fawole et al., 2010).

Midwives: Healthcare professionals trained in managing pregnancy, labour, and postpartum care, who are responsible for monitoring and supporting safe deliveries (Lavender, Hart, & Smyth, 2013).