Evaluating Modern Intrapartum Care Models: Can the World Health Organization Labor Care Framework Function as a...

In 2020, the World Health Organization (WHO) unveiled the Labor Care Framework, synthesizing person-centered approaches with scientifically validated labor management methodologies. Maternal complications during labor account for approximately 33% of global maternal mortality. This randomized trial evaluated whether the Labor Care Framework adequately replaces the partograph in low-risk pregnancies within resource-rich tertiary settings.

Between December 2021 and May 2023, 88 pregnant individuals with uncomplicated gestational ages 37-40 weeks were randomized: Labor Care Framework (n = 44) or Modified Partograph (n = 44). Primary outcomes included operative delivery frequency, active labor duration, and maternal morbidity (hemorrhage and infection). Secondary outcomes encompassed neonatal Apgar scores and intensive care requirements.

Operative delivery frequency was equivalent at 6.82% in both cohorts. Active labor duration averaged 3 h 55 min (framework) versus 4 h 16 min (partograph) - a nonsignificant 22-min difference. All neonates achieved Apgar scores ≥7 at 1-min and ≥9 at 5-min intervals. The framework group experienced zero maternal pyrexia, proven neonatal infection, or perinatal mortality. Blood loss and augmentation utilization were comparable between approaches.

Among trained personnel in adequately resourced academic institutions, the WHO Labor Care Framework demonstrates equivalent safety compared to the Modified Partograph. The framework's emphasis on systematically recording assistance and incorporating pregnant individuals' preferences represents a scientifically supported alternative to conventional surveillance-centered monitoring,enabling woman-centered intrapartum care without safety compromise.