Perceived Barriers Among Midwives to Implementation of the Modified Partograph in a Public Hospital in Gauteng Province, South Africa

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Abstract
Introduction: Partograph monitoring aims to assist midwives, obstetricians, and other healthcare professionals in a midwifery/obstetric unit to diagnose and manage labor to reduce the risk of prolonged labor, augmentation, cesarean sections, shoulder dystocia, and intrapartum stillbirths. The modified partograph is a new evidence‐based labor monitoring tool to assist with assessment and decision‐making during labor. Delayed implementation of the modified partograph was observed in the obstetric unit of the particular public hospital, while the previous partograph remained in use. It was not clear what barriers were related to the delayed implementation. Aim: The aim was to describe the perceived barriers by midwives to implementing the modified partograph in the obstetric unit of a public hospital in Gauteng province, South Africa. Methods: A qualitative descriptive contextual design was followed. The total population of all employed midwives at the hospital's obstetric unit was invited, focus groups were conducted until data saturation was reached, and data were analyzed using thematic analysis. All participants who met the inclusion criteria were invited. Results: Barriers identified included inadequate roll‐out of the modified partograph, insufficient understanding of the differences between the old and modified partographs, and material resource challenges. Conclusion: Recommendations were made to overcome the barriers. The study stressed the need to roll out the modified partograph across all levels of care and to all relevant stakeholders, including the importance of adequate training. Sustained training, mentorship, audit systems, and health‐system strengthening should be introduced to prevent confusion about the interpretation of the differences between the partographs and how to ensure complete record keeping.

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