Implementing the WHO Labor Care Guide to Reduce Cesarean Section Use in India: A Cluster Randomized Pilot Trial

Joshua Vogel of the Burnet Institute in Australia will generate evidence to support adoption of the new WHO Labor Care Guide to reduce the rate of cesarean sections and enhance the quality of care during childbirth by developing an implementation strategy for hospitals in India. In many low-middle income settings, women giving birth in busy hospitals are often alone, undermedicated, and inappropriately monitored, which increases the rates of cesarean sections. The WHO Labor Care Guide is a decision support tool for health workers to more effectively monitor labor progress and provide appropriate medical and supportive care. However, it has not been widely adopted. They will hold a workshop with providers, hospital administrators, and women's groups to develop and refine their implementation strategy. They will then conduct a cluster-randomized pilot trial in four maternity hospitals in India to test their strategy and evaluate its effect on the rate of cesarean sections and women's childbirth experiences.