Knowledge, attitude, and practice of birth attendants regarding partograph use and its association with birth...

The partograph is a World Health Organization (WHO)-recommended tool for monitoring labor and supporting timely clinical decisions. Despite its importance, its use remains suboptimal in many low- and middle-income settings, with persistent gaps between knowledge and practice. Evidence from Iran across different categories of birth attendants is limited. This study therefore assessed partograph use among midwives, obstetrics residents, and midwifery students, and its association with selected maternal and neonatal outcomes in teaching hospitals in Ahvaz, southwest Iran.

This cross-sectional study was conducted in 2023 in four teaching hospitals in Ahvaz, southwest Iran. A total of 155 birth attendants completed self-administered knowledge and attitude questionnaires. The practice of the birth attendants during 371 deliveries was evaluated through direct observation by a researcher, using a standardized observational checklist with predefined criteria. Data were analyzed using SPSS version 20, and chi-square and one-way analysis of Variance (ANOVA) tests were applied, with statistical significance set at P ≤ 0.05.

The mean knowledge score of the participants was 15.04, and there was no significant statistical difference between the three groups birth attendants in this regard (P = 0.230). The mean attitude score was 69.00. 66% of the participants had a positive attitude towards the partograph, and a significant statistical difference was observed between birth attendants (P = 0.001). Also, 57.2% of the partograph forms were not completed during labor, 39.6% were incomplete, and only 3.2% of the forms were completed fully and standardly. The chi-square test showed that there was a significant statistical relationship between the type of birth attendance and the completion of the partograph (p = 0.001). The duration of the first stage of labor, the 1st-minute Apgar score, postpartum hemorrhage, the need for resuscitation, and the need for Neonatal Intensive Care Unit (NICU) admission were significantly associated with the completion of the partograph (P < 0.05).

According to the results of this study, despite the acceptable knowledge and attitude scores of obstetric caregivers, the level of partograph use was still very low. Alongside continuous training, appropriate policy-making and structured implementation protocols are essential to ensure optimal partograph use and improve maternal and neonatal outcomes.