The Norwegian World Health Organisation Labour Care Guide Trial

What this Trial Is About

Researchers are evaluating the Labour Care Guide (LCG), a new tool designed by the World Health Organization to improve the quality and safety of care during childbirth by replacing the previous WHO partograph. This trial aims to test the LCG's effect on labor interventions and maternal and neonatal outcomes in Norway, focusing especially on cesarean section rates and women's experience of labor. The study is important because the LCG has not yet been tested in high-income settings like Norway, and the results will guide possible national implementation. The trial uses a stepped wedge multicenter cluster randomized design involving ten hospitals across Norway. Initially, all sites will use the WHO partograph as standard care, then switch to using the LCG according to a randomized schedule. The study consists of three parts: developing and testing an electronic version of the LCG, conducting the randomized trial to compare outcomes using the LCG versus the partograph, and surveying women about their childbirth experience using a questionnaire. Women with planned vaginal deliveries will be included unless they opt out. Participants will be monitored throughout labor using either the WHO partograph or the LCG depending on the hospital's phase in the trial. Researchers will collect data on labor interventions, maternal health, neonatal outcomes, and childbirth experience. Outcomes measured include cesarean section rates, instrumental vaginal delivery, perineal tears, postpartum hemorrhage, oxytocin use, pain relief methods, fetal monitoring, neonatal Apgar scores, and neonatal intensive care admissions. The trial will last 18 to 20 months, with thorough documentation and local coordinators ensuring adherence to the protocol.

The Norwegian World Health Organisation Labour Care Guide Trial (NORWEL)