Acceptability of the WHO labor care guide among midwives in Tanzania: an exploratory qualitative study

The World Health Organization's Labor Care Guide (LCG) is a next-generation partograph designed to improve intrapartum care by promoting accurate monitoring, critical thinking, and woman-centered practices. Evidence from low- and middle-income countries suggests that the LCG is generally practicable and acceptable among maternity care providers. Tanzania adopted the LCG in 2023, but little is known about its acceptability among frontline midwives in routine practice.

We conducted an exploratory qualitative study in a Municipality located in northwestern Tanzanian between May and June 2025. Twenty participants (midwives) from public health facilities were purposively selected. Data were collected through in-depth interviews guided by the Theoretical Framework of Acceptability (TFA), focusing on perceived effectiveness, burden, and intervention coherence. Interviews were transcribed, translated, and analyzed using Braun and Clarke's thematic analysis approach.

Three major themes emerged: (i) perceived effectiveness, participants viewed the LCG as a structured tool that could support labor monitoring (systematic assessment of fetal heart rate, labor progress, and early detection of complications), facilitates timely decision-making, which could support maternal and neonatal outcomes; (2) perceived burden, increased documentation workload and time demands compared to the traditional partograph, particularly under staffing constraints; and (3) intervention coherence, most participants understood the LCG's objectives and alignment with clinical practice, though challenges with some unfamiliar notation and contraction assessment were noted.

Participants generally perceived the LCG as acceptable tool for improving intrapartum care. However, contextual barriers such as increased workload, inadequate staffing, and integration into existing workflows were highlighted. Policy efforts should prioritize on-the-job training, workflow adaptation, and regular supportive supervision. Future research should employ mixed-methods and longitudinal designs to assess sustained LCG acceptability and effect on maternal and neonatal outcomes.