How the cases are made
Each six-character code runs one invented labour forward in half-hour steps: dilatation at a steady rate for its pattern (normal, slow, prolonged, weak contractions, obstructed or fetal distress), descent that follows it, contractions that strengthen, and the fetal heart and maternal observations. Only then are the notes written, so the guide, the notes and the key always agree.
The guide starts at 5 cm, each column is one clock hour, and the fetal heart and contractions take two half-hour cells per hour. Examinations are 4 hours apart unless there is a reason, such as an urge to push.
Example: a cervix that stops at 7 cm
In case GDP6TK, Mrs P (para 2) is 5 cm at 08:00, so the guide starts in the first column with 08:00 in the time row. At 12:00 she is 7 cm: the cervix has progressed, so that X is not circled, but the occiput transverse position and her blood pressure of 142/92 are. At 16:00 she is still 7 cm. That is 4 hours at 7 cm, past the 3-hour limit, so that X is circled, together with moulding +++, caput +++, the occiput transverse position and a blood pressure of 150/97. Open this case.
What the Alert column checks
| Row | Circle when |
|---|---|
| Companion, pain relief, oral fluid | N (no); D (declined) is not an alert |
| Posture | SP (supine) |
| Baseline fetal heart rate | under 110, or 160 and above |
| FHR deceleration | L (late) |
| Amniotic fluid | M+++ (thick meconium) or B (blood) |
| Fetal position | P or T (occiput posterior or transverse) |
| Caput, moulding | +++ |
| Pulse | under 60, or 120 and above |
| Systolic / diastolic BP | under 80 or 140 and above / 90 and above |
| Temperature | under 35.0, or 37.5 °C and above |
| Urine | protein ++ or acetone ++ |
| Contractions per 10 minutes | 2 or fewer, or more than 5 |
| Duration of contractions | under 20 or over 60 seconds |
| Cervix | no progress for 6 h at 5 cm, 5 h at 6 cm, 3 h at 7 cm, 2.5 h at 8 cm, 2 h at 9 cm |
Levels and classes
Plot only gives the notes and a blank guide. Interpret only gives a filled guide and questions. Full case gives both. Share with class copies a link to the same case; set Cases to a number before printing and each student gets a different labour, with the keys at the end.
Questions people ask
When do you start the WHO Labour Care Guide?
When the woman is in the active first stage of labour: the cervix is 5 cm or more, whatever her parity and whether or not the membranes have ruptured. Findings before that are latent phase and go in her notes, not on the guide.
What does the Alert column mean?
It lists the value for each row that needs attention, such as a baseline fetal heart rate under 110 or 160 and above, or diastolic pressure of 90 and above. The guide says to circle any entry that meets it, alert the senior midwife or doctor, and record the assessment and action taken.
What are the time limits for cervical dilatation?
An alert is triggered when the cervix stays at the same dilatation for its lag time: 6 hours at 5 cm, 5 hours at 6 cm, 3 hours at 7 cm, 2.5 hours at 8 cm and 2 hours at 9 cm. This site counts the time from the examination that first found that dilatation.
How often are observations recorded on the Labour Care Guide?
In the active first stage: fetal heart rate and contractions every 30 minutes, a vaginal examination every 4 hours, and pulse, blood pressure, temperature and urine every 4 hours when normal. Oxytocin is recorded every hour. Each column of the guide is one clock hour.
What is the second stage limit on the Labour Care Guide?
The alert is reached when the baby is not born 3 hours after the start of the active second stage in a nulliparous woman, or 2 hours in a multiparous woman. Pushing is marked with a P in the second-stage columns.
How is the Labour Care Guide different from the partograph?
The modified partograph starts at 4 cm and uses an alert line at 1 cm per hour with an action line 4 hours to its right. The Labour Care Guide starts at 5 cm, drops the lines, and checks each observation against its own threshold, including supportive care such as a companion, pain relief, fluids and posture.
Source: WHO, WHO labour care guide: user's manual, 2020 (ISBN 9789240017566), licensed CC BY-NC-SA 3.0 IGO. Checked 25 October 2026.