WHO labour care guide: scientific rationale, global adoption, and early policy implementation in the Republic of Moldova

Abstract

Abstract The traditional WHO partograph has been used globally for decades as a standard tool for intrapartum labor monitoring. However, accumulating evidence has challenged its underlying assumptions, particularly the use of rigid cervical dilatation thresholds, and highlighted the need for a more individualized and woman-centered approach to childbirth care. In response, the World Health Organization (WHO) introduced the Labour Care Guide (LCG) in 2020, aligned with the 2018 WHO recommendations on intrapartum care for a positive childbirth experience. This narrative review aims to examine the scientific rationale, global implementation experience, and policy implications of the WHO Labour Care Guide, with a particular focus on its relevance and application in the Republic of Moldova. A narrative review of peer-reviewed literature, WHO normative documents, FIGO position statements, and international implementation studies was conducted. National policy documents and clinical guidelines from the Republic of Moldova were analyzed to contextualize local adoption. International evidence demonstrates that the WHO Labour Care Guide supports individualized labor monitoring, reduces unnecessary obstetric interventions, and promotes respectful, woman-centered care without compromising maternal or neonatal safety. In 2025, the Republic of Moldova approved a new national guideline on intrapartum care, aligned with WHO principles and the conceptual framework of the Labour Care Guide. This policy shift reflects a strategic effort to improve the quality of intrapartum care and address ongoing challenges in maternal health outcomes. The transition from the classical WHO partograph to the principles underpinning the WHO Labour Care Guide represents a significant evolution in intrapartum care. The Republic of Moldova’s experience illustrates how countries with a long tradition of structured labor monitoring can adopt WHO-aligned, woman-centered approaches through national policy reform. Ongoing evaluation of implementation, including assessment of healthcare providers’ preparedness and perceptions, will be essential to ensure sustainable integration and to maximize potential benefits for maternal and neonatal health.