Mothers’ and Healthcare Providers’ Experiences with the Implementation of the WHO Labour Care Guide in Selected Hospitals in Zambia

<title>Abstract</title> <p>Background The partograph is a tool that provides a pictorial presentation of labour and provides a good overview of labour progress. The partograph application remains incorrect in many settings. Even when applied correctly, birth attendants reported gaps in use for labour management due to lack of access to resources such as enough skilled staff, clinical supplies, and training and supervision. Thus, the labour care guide was designed to be the next generation labour management tool. Objective This study aimed to explore the experiences of healthcare workers and mothers in the application of WHO Labour Care Guide in selected hospitals of Zambia. Methodology: A qualitative descriptive study design was conducted in selected hospitals of Zambia. Interviews from mothers and health care providers were analysed using thematic analysis. A hybrid inductive–deductive approach was applied, allowing participants’ lived experiences and language to shape the findings while maintaining alignment with the study’s implementation focus on the WHO Labour Care Guide and domains reflected in the interview guides. Findings: Mothers associated positive childbirth experiences with respectful communication, encouragement, responsiveness, and practical labour support. Birth companionship was valued for reassurance and support but was constrained by overcrowding, privacy concerns, and partners restrictions. Providers reported that the LCG strengthened clinical reasoning by linking assessment, interpretation, planning, action, and escalation. Documentation of plans and provider initials improved accountability and clinical governance. The LCG was also perceived to allow adequate labour progress, reducing premature interventions and unnecessary caesarean sections. Implementation challenges included difficulty meeting monitoring and documentation intervals during busy shifts, resulting in delayed plotting and partial completion. Although training improved confidence, not all staff were trained, leading to reliance on manuals and peer summaries. Peer-to-peer learning supported diffusion but risked incomplete knowledge transfer and copying practices. Referral challenges arose when women arrived with partographs, underscoring the need for system-wide alignment, pre-service training, and continued mentorship. Conclusion The findings suggest that the WHO Labour Care Guide was generally valued by mothers and health care providers for promoting respectful care, structured clinical reasoning, accountability, and more appropriate labour management. However, effective implementation was constrained by staffing pressures, documentation workload, inconsistent training, privacy limitations, and weak referral alignment. Sustained mentorship, wider training, and system-wide integration are therefore essential to strengthen LCG use and improve the quality of intrapartum care.</p>