ORIGINAL ARTICLE 468 P J M H S Vol. 12, NO. 1, JAN – MAR 2018 Why did not midwives use partograph correctly? INDRAYANI, MOUDY E. U. DJAMI ABSTRACT Background. WHO has developed the concept of partograph and recommended it as auxiliary tool to monitor progress of first stage of labour, detect complicating factors, and help midwives in decision making. Though various studies have proven the beneficial use of partograph, application of birth progress monitoring is not done properly. Aim: To observe midwives’ obedience in using partograph and explore the obstacles. Method. The study used mixed methods with sequential explanatory strategy. Quantitative study used cross-sectional design with observational method. Qualitative study used phenomenological approach through thorough interviews. Data collecting was done in November 2014 to March 2015 in health facilities in Bandung City, Bandung and Sukabumi Regency. 53 midwives were observed during childbirth processes and 27 involved in thorough interviews. Result. Observation showed 60.4% of midwives used partograph incompletely. Midwives had obstacles in using partograph properly. Knowledge was not main factor causing inobedience. Other contributing factors were skills, training, time with midwife-patient ratio, work burden, formality, supporting system, application of discipline/sanction, attitude. Conclusion. There are many obstacles faced by the midwives in applying partographs to monitor the birth progress and these conditions make its application to become unreasonable. Government needs to re-evaluate the policy of partograph usage. Keywords: Midwives, partograph, knowledge, skills, training, time with midwife-patient ratio, work burden, formality, supporting system, application of discipline/sanction, attitude. INTRODUCTION The problem of mother and baby’s mortality is still a global issue. World Health Organization (WHO) has made efforts to reduce the mortality cases. One of it is by developing the concept of partograph and recommending it as an auxiliary tool to monitor the progress of first stage of labour, detect the complicating factors of it, and help midwives in decision making. WHO promotes partograph as a cosy and efective protocol management 1 . The decision to recommend partograph has been made after carrying out various stages. Partograph which is adapted from Philpott and Castle was investigated by WHO through non-randomised prospective studies in 35,484 South East Asian women, and WHO concluded that partograph was an important instrument in birth management and recommended the use of it universally 2 . Partograph has practical benefits in its easy use, time, sustainability, support of education on the right time to do intervention 3 including intervention in troubled birth and recommendation of other interventions before making reference. This action enables prevention of complication in troubled birth by early detection so that clinical treatment can be applied in ----------------------------------------------------------------------------------------- Akademi Kebidanan Bina Husada, Tangerang Correspondence to Indrayani, Akademi Kebidanan Bina Husada, Tangerang. Kutai Raya No.1, Bencongan Kelapa Dua, Tangerang, Banten, Indonesia. Zip Code 15811 Ph. +6221-55655372 Fax. +6221-55655372. Email: indrayani_akbid@yahoo.co.id the right time. It is important to do this remembering that troubled birth is a significant cause of morbidity as well as mother and baby’s mortality 3,4 . Routine use of partograph will ensure that mothers and babies get a safe treatment in the right time. This will eventually reduce the mortality rate of mothers and babies. Though WHO has supported the use of partograph and various studies have proven the beneficial use of it, the application of birth progress monitoring using partograph has not been done properly 1 . This is in line with the study in Uganda which showed that the use of partograph was only 30% of all child births, and 57.1% of medical personnels in Community Health Centre never used partograph to monitor the birth progress. Even in other health facilities, only 2% used partograph in accordance with the standard to monitor the fetal heart rate. The data showed that medical personnels should be blamed on their bad attitude, lack of self confidence, and lack of skills on the use of partograph 5 . Low use of partograph was not only reported in Uganda but also in Ghana, 6 Ethiopia 7,8,9 , Tanzania 10 and Southern India. 11 Some Midwifery units also reported that partograph had limited clinic practices, confined the midwife’s authority and restricted the flexibility to treat a woman as an individu 3 which were considered a bad factor for both clinical and psychological outcomes. In a qualitative study carried out in Kenya, midwifery