Publication:

Impact of a standardized labour room management protocol on labour processes and World Health Organization Robson classification – a quality dashboard-based study

Background Crude caesarean section (CS) rates inadequately capture labour room quality because they are confounded by case mix. We evaluated a standardized labour room management protocol using a multidimensional labour room quality dashboard incorporating the World Health Organization (WHO) Robson ten-group classification system (TGCS).

Methods This retrospective before-and-after quality improvement study compared all deliveries during two identical one-month periods-July 2024 (pre-intervention, n=58) and July 2025 (post-intervention, n=76)-at a tertiary care teaching hospital in India. Labour process, delivery outcome, workflow, case-mix, and Robson-group indicators were compared using chi-square or Fisher’s exact test. Multivariable logistic regression identified independent predictors of CS.

Results Spontaneous onset of labour increased from 29.3% (17/58) to 60.5% (46/76), while induction decreased from 44.8% (26/58) to 13.2% (10/76) (χ²=19.10, p<0.001). Overall CS rates remained unchanged (39.7% versus 40.8%; p=1.000), as did daytime versus night-time delivery (84.5% versus 86.8%; p=0.890). Robson group 1 increased from 1.7% to 25.0%, while induction-related group 4a decreased from 22.4% to 1.3% (χ²=41.08, df=9, p<0.001). No individual Robson group showed a significant change in internal CS rates. On adjusted regression, the post-intervention period was not independently associated with CS (aOR 1.55, 95% CI 0.70-3.41, p=0.281); induction showed a non-significant trend toward higher CS odds (aOR 2.41, 95% CI 0.99-5.88, p=0.053).

Conclusions The standardized protocol reduced induction and increased spontaneous labour without changing CS rates or birth timing. A multidimensional dashboard may provide a more informative assessment of labour ward performance than CS rate alone.