Utilization of Partograph at Term Labour Among Nurses and Midwives in Rivers-East Senatorial District, Rivers State, Nigeria

number RSHMB/RSHREC/2023/059 was obtained from the Rivers State Health Research Ethics Committee. Approval letters were also obtained from the Rivers State Primary Healthcare Management Board. Oral consent was obtained from the participants and respondents after the necessary information regarding the research has been provided to them and confidentiality was maintained by keeping the participants anonymous. Results The results of the study are shown below: Table 1: The Extent of Partograph use in Labour at Term among Nurses and Midwives in Rivers-East. S/N Items on the Prevalence Min Max Mean SD 1. Do you believe that partograph use is essential for managing Labour effectively? 1.0 0 5.00 1.2619 .58153 2. In your opinion, does partograph use help reduce maternal complications? 1.00 3.00 1.2982 .59305 3. Do you believe using a partograph improves neonatal outcomes? 1.00 4.00 1.5731 .70225 4. How comfortable are you with using the partograph? 1.00 4.00 1.6433 .71636 5. Do you believe partograph use should be mandatory during Labour? 1.00 3.00 1.4561 .65269 6. Do you feel motivated to use the partograph during Labour management? 1.00 3.00 1.1637 .49358 7. How well do you think the partograph is integrated into routine Labour management? 1.00 3.00 1.6667 .68924 8. Do you think the benefits of using the partograph outweigh the time spent filling it out? 1.00 3.00 1.3626 .63022 The findings from table 1 demonstrate that nurses and midwives in Rivers-East generally hold very positive attitudes toward the use of the partograph in labour at term, though their responses reveal some variation in comfort and integration into routine practice. The mean score for the belief that partograph use is essential for managing labour effectively was 1.26 with a relatively low standard deviation, indicating strong consensus among respondents that the tool is indispensable in labour management. Similarly, the mean score of 1.30 for the belief that partograph use helps reduce maternal complications reflects widespread agreement that the tool plays a critical role in preventing adverse maternal outcomes. When asked whether partograph use improves neonatal outcomes, the mean score was slightly higher at 1.57, suggesting that while most respondents recognize its benefits for newborns, there is somewhat less certainty compared to maternal outcomes. Comfort with using the partograph also showed a higher mean of 1.64, indicating that although respondents value the tool, some feel less confident in applying it consistently. This variability may be linked to differences in training, experience, or institutional support. The belief that partograph use should be mandatory during labour had a mean score of 1.46, showing general agreement but with slightly more variation than the items on maternal outcomes. Motivation to use the partograph during labour management recorded the lowest mean score of 1.16, highlighting very strong motivation among respondents and suggesting that intrinsic willingness to use the tool is not a limiting factor. Perceptions of how well the partograph is integrated into routine labour management produced the highest mean score of 1.67, pointing to weaker integration despite positive attitudes. This gap between belief and practice suggests that systemic barriers such as workload, staffing shortages, or lack of supervision may hinder consistent use. Finally, the perception that the benefits of using the partograph outweigh the time spent filling it out had a mean score of 1.36, showing general agreement but also some recognition that documentation can be burdensome. Taken together, these findings reveal an attitudinal-practice gap. Nurses and midwives strongly value the partograph and are motivated to use it, but their comfort levels and perceptions of integration into routine practice are weaker. This indicates that while knowledge and motivation are high, practical challenges reduce utilization. Addressing these barriers through enhanced training, mentorship, supportive supervision, and workflow integration could help translate positive attitudes into consistent practice, ultimately improving maternal and neonatal outcomes. Table 2: The Attitude of Nurses and Midwives on Partograph Use During Labour at Term S/N Items Min Max Mean S/D 1. Have you received formal training on the use of the partograph? 1.00 2.00 1.0526 .22395 2. If yes, what was the source of your training? 1.00 3.00 1.5128 .81508 3. Do you feel your training on the partograph was sufficient? 1.00 2.00 1.2848 .45272 4. How familiar are you with the partograph’s key components? 1.00 3.00 1.4107 .52859 5. Are you aware of the alert and action lines on the partograph? 1.00 2.00 1.0877 .28372 6. What is the main purpose of the alert line on a partograph? 1.00 3.00 1.5556 .53452 7. What is the main purpose of the action line on a partograph? 1.00 2.00 1.1273 .33429 8. How often do you refer to official guidelines or protocols for partograph usage? 1.00 5.00 1.8772 1.03589 9. Do you know when to start using the partograph in labour? 1.00 3.00 1.0526 .29232 10. What does cervical dilation on the partograph represent? 1.00 4.00 1.0702 .41415 11. Is continuous partograph use emphasised in your facility’s protocols? 1.00 2.00 1.1404 .34837 The results in table 2 provide insight into the attitudes of nurses and midwives toward partograph use during labour at term. Overall, the mean scores are clustered close to 1, which suggests generally positive attitudes and high levels of awareness, though with some variation in training sufficiency, familiarity with components, and reliance on guidelines. The very low mean score of 1.05 for whether respondents had received formal training indicates that nearly all participants reported having undergone some form of training on partograph use. However, when asked about the source of their training, the mean score was higher at 1.51 with a relatively large standard deviation, showing that training sources varied widely and were not uniform. This variability may reflect differences in institutional approaches, with some staff trained through formal curricula and others through workshops or on-the-job mentorship. The sufficiency of training was rated with a mean of 1.28, suggesting that most respondents felt their training was adequate, though not universally so. Familiarity with the partograph’s key components had a mean of 1.41, indicating general familiarity but with some respondents less confident in their knowledge. Awareness of the alert and action lines was very high, with mean scores of 1.08 and 1.12 respectively, showing that nearly all respondents understood these critical features. However, when asked about the main purpose of the alert line, the mean score rose to 1.55, suggesting that while awareness exists, deeper understanding of its function is less consistent compared to the action line. The frequency of referring to official guidelines or protocols had the highest mean score of 1.87 and the largest standard deviation, indicating that while some respondents regularly consult guidelines, others rarely do. This variability points to differences in institutional culture and individual practice, and it highlights the need for stronger reinforcement of guideline use. Knowledge of when to start using the partograph in labour was nearly universal, with a mean score of 1.05, and understanding of cervical dilation representation was also very high at 1.07. Finally, whether continuous partograph use is emphasized in facility protocols had a mean of 1.14, suggesting that most respondents perceive institutional support for consistent use, though not all facilities may enforce it equally. Taken together, these findings show that nurses and midwives in Rivers-East generally have positive attitudes toward partograph use, with strong awareness of its components and functions. However, variability in training sources, sufficiency, and reliance on guidelines suggests that while attitudes are positive, practice may be uneven. The relatively higher mean scores for familiarity with components, understanding of the alert line, and consultation of guidelines point to areas where reinforcement is needed. Strengthening standardized training, ensuring clarity on the purpose of the alert line, and embedding guideline use into routine practice would help translate these positive attitudes into consistent and effective utilization. Table 3: Result of Spearman Correlation Analysis of Year of Experience on Partograph Utilization YE PP1 PP6 PP8 PP9 PP12 Spearman's rho Years of Experience (YE) Correlation Coefficient 1.000 .143 -.134 .107 -.014 -.055 Sig. (2-tailed) . .065 .082 .167 .858 .479 N 363 168 169 168 168 168 How often do you use a partograph (PP1) Correlation Coefficient .143 1.000 - .368** -.091 .126 - .310** Sig. (2-tailed) .065 . .000 .247 .106 .000 N 363 168 166 165 165 165 How often do you complete the partograph from start to finish (PP6) Correlation Coefficient -.134 - .368** 1.000 .014 -.098 .218** Sig. (2-tailed) .082 .000 . .854 .209 .005 N 363 166 169 166 166 166 Do you discuss findings with team members (PP8) Correlation Coefficient .107 -.091 .014 1.000 -.031 .172* Sig. (2-tailed) .167 .247 .854 . .692 .026 N 363 165 166 168 168 168 How often do you experience interruptions (PP9) Correlation Coefficient -.014 .126 -.098 -.031 1.000 -.114 Sig. (2-tailed) .858 .106 .209 .692 . .142 N 363 165 166 168 168 168 Are findings discussed during shift handovers (PP12) Correlation Coefficient -.055 - .310** .218** .172* -.114 1.000 Sig. (2-tailed) .479 .000 .005 .026 .142 . N 363 165 166 168 168 168 **. Correlation is significant at the 0.01 level (2-tailed).*. Correlation is significant at the 0.05 level (2-tailed). The Spearman’s rho correlation results provide a nuanced picture of how years of experience and various aspects of partograph use are related among nurses and midwives. The correlations between years of experience and the partograph-related variables were weak and not statistically significant. For example, the relationship between years of experience and frequency of partograph use showed a small positive correlation (r = .143, p = .065), while years of experience and completion of the partograph showed a weak negative correlation (r = –.134, p = .082). These results suggest that length of service does not strongly predict how often nurses and midwives use or complete the partograph, discuss findings, or experience interruptions. In practice, both junior and senior staff demonstrate similar patterns of use, indicating that systemic factors rather than individual experience may be more influential in shaping utilization. A significant negative correlation was observed between how often respondents use the partograph and how often they complete it from start to finish (r = –.368, p < .001). This finding highlights a quality versus quantity issue: while some staff may initiate partograph documentation frequently, they do not always complete it fully. This reflects a practice gap where documentation is started but not consistently carried through, possibly due to workload pressures, interruptions, or lack of supervision. Similarly, a significant negative correlation was found between frequency of partograph use and whether findings are discussed during shift handovers (r = –.310, p < .001). This suggests that frequent use does not necessarily translate into effective communication of findings, pointing to a disconnect between documentation and team communication. On the other hand, positive correlations were found between completion of the partograph and discussions during handovers (r = .218, p = .005), and between team discussions and handover discussions (r = .172, p = .026). These results emphasize the importance of complete documentation for effective team communication. When the partograph is fully completed, it is more likely to be used as a communication tool, reinforcing its value in continuity of care. Staff who engage in collaborative discussions are also more consistent in ensuring information is passed on during transitions, reflecting a culture of communication that strengthens teamwork and patient safety. Interruptions did not show significant correlations with other variables, suggesting that while interruptions are a common challenge, they affect all staff regardless of experience or documentation habits. This points to the need for system-level interventions, such as improved staffing and workflow redesign, to minimize disruptions during labour monitoring. Overall, the analysis reveals that years of experience alone does not drive partograph use or completion. Instead, institutional support, training, and communication culture appear to be the key determinants. Frequent use without completion undermines the effectiveness of the tool, while completed partographs enhance team discussions and handovers. Addressing systemic barriers such as workload, interruptions, and inconsistent training will be critical to translating positive attitudes into consistent, high-quality practice. Discussion of Findings The findings of the study were discussed The results provide a nuanced picture of how nurses and midwives in Rivers-East perceive and utilize the partograph in spontaneous labour at term. Overall, the data suggest that respondents hold strong positive attitudes toward the tool, but their actual comfort with using it and perceptions of its integration into routine practice are weaker, pointing to an attitudinal-practice gap that is consistent with findings from other low- and middle-income countries (Bahizi et al., 2023). The very low mean scores for items such as the belief that partograph use is essential for managing labour effectively (mean = 1.26) and the perception that it helps reduce maternal complications (mean = 1.30) demonstrate widespread consensus on its importance. These results align with studies in Ethiopia and Nigeria, where health workers consistently acknowledged the clinical value of the partograph in preventing prolonged labour and maternal morbidity (Hagos, Teka, & Degu, 2020; Opiah, Ofi, Essien, &Monjok, 2012). Similarly, motivation to use the partograph during labour management recorded the lowest mean score of 1.16, indicating that respondents are highly motivated and willing to use the tool. This intrinsic motivation is encouraging, as it suggests that the main barriers to utilization are not attitudinal but structural. When asked whether partograph use improves neonatal outcomes, the mean score was slightly higher at 1.57, showing that while respondents recognize its benefits for newborns, there is less certainty compared to maternal outcomes. This finding is consistent with Bahizi et al. (2023) in Ghana, who reported that compliance with fetal heart rate monitoring was the lowest among partograph parameters, suggesting that neonatal outcomes are sometimes undervalued in practice. Comfort with using the partograph also had a relatively high mean score of 1.64, indicating variability in confidence levels among respondents. This variability may reflect differences in training, exposure, and supervision, as highlighted by Khan et al. (2018) in Bangladesh, who found that incorrect recording of fetal heart rate and cervical dilatation was common, pointing to gaps in skill and confidence. The perception that partograph use should be mandatory during labour had a mean score of 1.46, showing general agreement but with slightly more variation than the items on maternal outcomes. This may reflect recognition of practical barriers such as workload, staffing shortages, and supply issues that complicate enforcement. Integration of the partograph into routine labour management produced the highest mean score of 1.67, suggesting that despite positive attitudes, respondents perceive weak institutional integration. This finding resonates with Mugyenyi et al. (2023), who reported that in many sub-Saharan African facilities, partograph use was poorly institutionalized, with inconsistent supervision and weak accountability mechanisms. Finally, the perception that the benefits of using the partograph outweigh the time spent filling it out had a mean score of 1.36, showing general agreement but also recognition that documentation can be burdensome, particularly in high-volume labour wards. These findings highlight a clear attitudinal-practice gap. Nurses and midwives strongly value the partograph and are motivated to use it, but their comfort levels and perceptions of integration into routine practice are weaker. This suggests that while knowledge and motivation are high, practical challenges reduce utilization. Addressing these barriers through enhanced training, mentorship, supportive supervision, and workflow integration could help translate positive attitudes into consistent practice. For example, Hailu et al. (2020) found that on-the-job training significantly improved health workers’ confidence and attitudes toward partograph use, while supportive supervision reinforced consistent application. Similarly, Abebe et al. (2013) emphasized that training alone is insufficient without mentorship and institutional support. In conclusion, the results from Rivers-East mirror broader regional trends: health workers recognize the importance of the partograph and are motivated to use it, but systemic barriers hinder consistent utilization. Interventions should therefore focus on bridging the gap between positive attitudes and practice by strengthening training, supervision, and institutional integration. Doing so will not only improve maternal outcomes, which respondents already value highly, but also enhance neonatal outcomes, which appear to be less emphasized in practice. By aligning interventions with both the intrinsic motivation of health workers and the systemic needs of facilities, Rivers-East can achieve more consistent and effective partograph utilization, ultimately reducing maternal and neonatal morbidity and mortality. The findings reveal generally positive attitudes toward partograph use among nurses and midwives in Rivers-East, but with variability in training sufficiency, familiarity, and reliance on guidelines. When compared with studies from Nigeria, Ethiopia, and Ghana, similar patterns emerge: health workers recognize the importance of the partograph but inconsistencies in training and institutional support hinder uniform practice, the very low mean score for formal training (1.05) indicates that nearly all respondents had received some form of training. However, the variability in training sources (mean = 1.51, SD = 0.81) suggests that training is not standardized. This finding mirrors evidence from Nigeria, where Lami (2022) published a study titled “knowledge and Attitude Towards Utilisation of Partograph Among Midwives in Selected Hospitals in Gombe State”, reported that while most midwives had been exposed to partograph training, the quality and depth varied significantly across institutions, leading to uneven confidence in its use. Similarly, in Ethiopia, Hagos et al. (2020) found that although many midwives had received training, gaps in refresher courses and mentorship limited their ability to apply the tool consistently BMC Pregnancy and Childbirth. In Ghana, Bahizi et al. (2023) highlighted that inadequate and inconsistent training contributed to poor completion rates of partographs, with only 25.6% adequately filled. The sufficiency of training in Rivers-East, with a mean score of 1.28, indicates that most respondents felt their training was adequate, though not universally so. This aligns with findings from Ethiopia, where Ayele et al. (2025) noted that health workers often reported training as sufficient but still struggled with practical application, particularly in high-volume facilities. Familiarity with key components of the partograph (mean = 1.41) was generally strong, yet some respondents expressed less confidence. This is consistent with Nigerian studies, such as Opiah et al. (2012), which found that while midwives were aware of the partograph’s components, many lacked detailed knowledge of how to interpret them effectively. Awareness of the alert and action lines was very high in Rivers-East (means = 1.08 and 1.12), but deeper understanding of the alert line’s purpose was weaker (mean = 1.55). This echoes findings from Ethiopia, where Adler et al (2020) reported that although most providers recognized the alert line, fewer understood its clinical implications for timely intervention. In Ghana, Bahizi et al. (2023) similarly noted that compliance with recording fetal heart rate and cervical dilatation—parameters closely linked to the alert line—was among the lowest, suggesting gaps in practical understanding. The frequency of referring to official guidelines had the highest mean score (1.87), indicating variability in reliance on protocols. This reflects broader challenges in institutional culture. In Nigeria, Sahay (2023) observed that while guidelines existed, many midwives relied on personal experience rather than formal protocols, leading to inconsistent practice. In Ethiopia, Hagos et al. (2020) found that supportive supervision and institutional emphasis on guidelines were critical predictors of consistent partograph use. Knowledge of when to start using the partograph (mean = 1.05) and understanding of cervical dilation representation (mean = 1.07) were nearly universal in Rivers-East, showing strong baseline knowledge. This is encouraging and consistent with findings across sub-Saharan Africa, where awareness of when to initiate partograph use is generally high. However, whether continuous use is emphasized in facility protocols (mean = 1.14) suggests that institutional enforcement is uneven. This finding resonates with Anim‐Somuah et al. (2018), who reported that in many African facilities, partograph use was poorly institutionalized, with weak accountability mechanisms. The Rivers-East findings demonstrate that while nurses and midwives have positive attitudes and strong awareness of partograph components, variability in training sources, sufficiency, and reliance on guidelines hinder uniform practice. These results are consistent with evidence from Nigeria, Ethiopia, and Ghana, where similar attitudinal-practice gaps have been documented. Strengthening standardized training, ensuring clarity on the purpose of the alert line, and embedding guideline use into routine practice are critical steps to translate positive attitudes into consistent utilization. Institutional support, including supervision and accountability, will be essential to sustain improvements. Conclusion and Recommendation It was concluded that partograph use helps reduce maternal complications and plays a critical role in preventing adverse maternal outcomes. The findings collectively reveal that while attitudes toward the partograph are generally positive, consistent and effective utilization is undermined by systemic barriers rather than individual motivation or years of practice. Ensuring reliable supply of partograph sheets is a basic and essential intervention. Although most respondents reported no problems accessing sheets, a significant minority faced challenges. Health facilities should strengthen procurement and inventory management systems to guarantee uninterrupted availability of partograph charts. This low-cost intervention would remove a fundamental barrier to utilization. References Abalos, E., Chamillard, M., Díaz, V., Pasquale, J., & Souza, J. P. (2020). Progression of the first stage of spontaneous labour. 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