On June 27, 2012, the Nana Yaa Memorial Trust for Good Quality Reproductive Health Services held a day’s round table conference to advocate for the adoption of the partograph with latent phase in all maternal health care provision institutions in Ghana. This was a follow –up to a previously held one day seminar on 10th November 2011 on why it is necessary to adopt the use of a partograph with latent in all health facilities where maternal health care is provided.
The partograph is a managerial tool for the prevention of prolonged labour and its complications. It is a graphical recording that shows at a glance:
• the progress of labour
• the salient conditions of the mother and
• the foetal condition

It is designed to detect any deviations from normal during labour.

Specifically it does the following:
• recognises cephalo-pelvic disproportion long before labour becomes obstructed
• indicates when intervention in labour is appropriate
• assists in early decision to transfer, augment or terminate labour.

The original partograph has two phases; the latent and active. The latent phase represents the onset of labour until 3cm of cervical dilatation within a period of 8 hours. The active phase represents the progress of labour from 3cm of cervical dilatation to full dilation of the cervix; i.e. 10cm, averagely 1cm per hour.

It is very essential to monitor these two phases to avoid prolonged labour and other complications such as foetal distress, cephalo-pelvic disproportion, obstructed labour, ruptured uterus, obstetric fistulae, post partum haemorrhage and ultimately maternal and/or neonatal death.
In the absence of the latent phase of labour monitoring, clients with the risk of cervical dystosia, precipitate labour and delivery as well as any of the above mentioned complications will be missed, thereby, increasing maternal and neonatal morbidity and mortality.

Indeed the latent phase also helps in timely referral of clients at risk of prolonged labour from a Level A or B to a well resourced health facility e.g. regional or tertiary hospitals for further positive management.

These observed conditions were also confirmed by a group of doctors who undertook a study at the Korle Bu Teaching Hospital using the partograph without the latent phase. “The client in latent phase of labour is no more entertained on the new partograph. But the latent phase of labour requires equally intensive monitoring for early detection and intervention.”

This is because in a study conducted by O’Driscroll, the father of the 12 hour active labour concept, ten percent of the women who were sent home as being in false labour or too early in labour returned to the hospital within 24 hours to deliver their babies. Also if this phase is delayed for longer than 8 hours in the presence of at least 2 contractions in ten minutes, the labour is more likely to be prolonged with a poor state of baby outcome according to prominent researchers. Therefore, if the woman is in a peripheral unit that is in the District she should be transferred to hospital. If she is in hospital she needs critical assessment and decision about subsequent management by an Obstetrician.

Therefore, once a woman calls in any health facility for delivery, she should be detained and monitored until she has her baby/babies.

SHE SHOULD NEVER BE ASKED TO GO HOME AND COME BACK BECAUSE:
• SHE MIGHT NOT COME BACK AGAIN IN GOOD STATE.
• SHE MIGHT DECIDE TO GO TO A TRADITIONAL BIRTH ATTENDANT (TBA) or A SPIRITUAL BIRTH ATTENDANT (SBA)
• COME BACK WITH A RUPTURED UTERUS AND NEONATAL DEATH.

Therefore, we, the under-mentioned members of this round table conference (names and signatories attached) strongly advocate and state as follows:
• The partograph with latent phase must be adopted for used in all health facilities in order to meet the Millennium Development Goals 4 and 5.
• The latent phase on the partograph should be re – inserted and used correctly by all skilled attendants (obstetricians, doctors, midwives, nurse – midwives) in the management of labour.
• Maternal health facilities should be expanded to accommodate every woman who presents herself in labour for confirmation and management within the facility.
• Obstetric theatres should be increased to prevent clients requiring emergency obstetric care from queuing for theatre management to avoid ruptured uterus and neonatal deaths.
• Both medical and midwifery students should be made to monitor clients using the partograph with latent phase during their period of training before claiming the clients as their case studies.
• Midwifery classes should not be more than forty students to a class to avoid large class numbers which will lead to inadequate experience in monitoring and deliveries babies before the end of their training.
• Every student should be mandated to watch at least ten deliveries and deliver at least ten clients before being acclaimed proficient.
• It should be mandatory for all maternal health care providers (doctors, midwifery tutors, midwives and other skilled attendants) to update their knowledge and skills and authenticated by authorized supervisors every three years.
We pray that these recommendations which have been carefully put together by the above named persons in midwifery practice would be accepted and implemented in order that Ghana would achieve the MDGs 4 & 5 by the year 2015.

Signed by:

1. Dr. J.B. Wilson Senior Lecturer, University of Ghana Medical School Korle Bu Teaching Hospital

2. Dr. Edmund K. Biga Obstetrician & Gynaecologist
Dept. of Obs & Gynae, Korle Bu Teaching Hospital

3. Mrs. Victoria Lamina Assistant Registrar, NMC for Ghana

4. Col. Augusta Wellington Officer In-Charge, 37 Military Hospital
Nurses and Midwifery Training School

5. Mrs. Netta F. Ackon Midwifery Tutor,
Nurses & Midwifery Training School, Korle Bu

6. Mrs. Gladys Kankam Consultant – Midwife, MOH

7. Nana Kusi – Yeboah Consultant – Midwife, MOH

8. Mrs. Felicia D. Darkwah Executive Secretary, Nana Yaa Memorial Trust
For Good Quality Reproductive Health Services

9. Lt Col Gladys Okwaning (Rtd) Chief Executive Officer, Nana Yaa Memorial Trust
For Good Quality Reproductive Health Services