It's a paper tool that helps doctors determine whether a woman's labour is progressing well — and an easier-to-use version will now be going to remote rural counties in sub-Saharan Africa thanks to two Manitoba doctors.

University of Manitoba professors Dr. Lisa Avery and Dr. Maryanne Crockett have developed a low-cost, graphless partograph — a paper graphing tool that tracks and records the health of the mother and unborn child while the mother is in labour.

A partograph is designed to let a health professional know if the labour is progressing well or if something is abnormal. While it's recommended by the World Health Organization for hospitals and clinics around the world to help spot potential problems during labour, they don't always get used in remote clinics or hospitals, said Avery.

"Around the world, in low-resource settings, it's probably used less than 10 per cent of the time," she said. "It has to do, one, with graphing skills, because it's an actual graph with an X and a Y axis with different timelines that you have to plot on. So there have been studies ... that have shown that people are just afraid to use it because graphing is difficult or they're not able to understand the graph and how to plot it and interpret it.

"There's also gaps in terms of training and labour management and how to recognize normal or abnormal labour."

To help combat those problems and increase the number of health professionals using partographs, the duo designed a graphless partograph that is easier to use. 

"We say now, based on new studies, if a woman goes into labour, [a woman's cervix should dilate] at least half a centimetre an hour," said Avery. Instead of graphs to keep track of that progress, the new form uses simple addition at four-hour intervals to determine if labour is progressing normally or abnormally.

"Ideally, if a partograph is used correctly, you should be able to decrease maternal and newborn morbidity or mortality such as death from obstructed labour," said Avery. 

Yearly deaths

Yearly, 280,000 women die during childbirth around the world, and two-thirds of those deaths happen in sub-Saharan Africa, said Avery. Thanks to a $100,000 grant from Grand Challenges Canada, partnerships made through the University of Manitoba and previous projects in Kenya, the pair will bring their new partograph to two counties in the sub-Saharan country and help facilitate training on its use. If the program is successful, they hope to expand. 

While the pair say their project is unlikely to make a significant dent in the number of maternal or fetal deaths during its one-year scope, they hope to see an increased use in partographs in the hopes midwives and other health providers will spot the abnormal progression of labour sooner.

"One of the things that often happens in global health is that people silo out the mother or the baby or the child, and really we like to think of it as a continuum," said Crockett. "It's a life cycle. If something happens to the mother, the child suffers. If something happens to the baby, the mother suffers. So we really can't separate it out."