Promoting respectful maternity care with the WHO labor care guide and the checklist mnemonic “COPE”: A quality improvement project

Abstract

Objectives: To improve the quality of intrapartum care at Princess Marina Hospital, Gaborone, Botswana, through a champion-led educational intervention, introduction of the World Health Organization's Labor Care Guide (LCG), which highlights four key measures to promote respectful maternal care (RMC). Methods: In August 2022, we engaged medical and nursing staff in interactive training on the WHO LCG and implemented a mnemonic-based checklist—“COPE” (Companions, Oral fluids, Pain relief, Eliminate the supine position). Motivational posters were displayed in the labor ward. Surveys to assess client labor experiences were conducted in November 2022 (n = 204) and October 2024 (n = 211). An anonymous staff survey assessed personal practice changes before and after the training. Results: Over 2 years, significant improvements in reported maternal experience were observed. Reports of a “very bad” experience decreased from 116/204 (56.9%) to 13/211 (6.2%) and dissatisfaction with care reduced from 22/204 (10.8%) to 3/211 (1.4%). Adequate fluid provision increased from 108/204 (52.9%) to 159/211 (75.4%) and pain relief from 41/204 (20.1%) to 108/211 (51.2%). The reported presence of a labor companion increased from 14/204 (6.9%) to 133/211 (63.0%). Patient reports of exclusive supine positioning during the second stage of labor decreased from 106/204 (52.0%) to 11/211(5.2%). Staff questionnaires showed a consistent improvement in reported adoption of “COPE” practices compared with recollected practices before the intervention. Conclusions: Deeply entrenched labor care practices are difficult to change; however, sustained, champion-led quality improvement interventions using the LCG and with sustained supportive supervision can yield meaningful improvement in women's birth experiences.