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Abstract

The global rise in cesarean section (CS) rates has become a major concern due to its association with increased maternal and neonatal complications without clear benefits in many cases. The World Health Organization (WHO) introduced the Labor Care Guide (LCG) in 2020 to improve labor monitoring, reduce unnecessary interventions, and promote positive birth outcomes. Objective: To assess the impact of the WHO LCG on reducing primary cesarean section rates and improving maternal and neonatal outcomes at a tertiary care hospital. Methodology: This randomized controlled trial was conducted over six months at Dow University Hospital, Ojha Campus, Karachi. Two hundred sixty pregnant women in spontaneous labor at 37–40 weeks' gestation were included. Participants were randomly allocated to the LCG group (n=130) or the control group (WHO-modified partograph; n=130). Maternal and neonatal outcomes were recorded, and healthcare provider feedback on LCG usability was collected using a 5-point Likert scale. Statistical analysis was performed using SPSS v16. Results: The cesarean section rate was significantly lower in the LCG group (12.3%) compared to the control group (25.4%) (p=0.007). The LCG group also showed higher rates of vaginal delivery (85.4% vs. 70.0%, p=0.003), shorter labor duration, and better postpartum hemoglobin levels. Neonatal outcomes were comparable between groups. Healthcare providers rated the LCG favorably, with high ease of use, acceptability, and satisfaction scores. Conclusion: The LCG of WHO significantly reduced primary cesarean sections and improved labor outcomes without compromising neonatal safety. It is a feasible, effective, and acceptable tool in clinical practice.