Table 1 Outline of domains, indictors, definitions, and rationale applied to assessment of competent intrapartum care processes

Patient safety hygiene practices limiting healthcare-associated infections throughout intrapartum period.

“Sterile precautions during vaginal examination”

“Handwashing/hand disinfection and use of sterile gloves with each vaginal examination.” Required input elements: Handwashing facility (any of the following: tap, water in a bucket with fitted tap, pitcher located inside maternity), sterile gloves (at least 5 pairs for health centers, 10 pairs for hospitals)

Vaginal examinations conducted in a sterile manner to limit risk of endometrial infections.

“Sterile precautions during assistance of childbirth”

“Handwashing/hand disinfection and use of sterile gloves during stage 2 labor and immediate newborn care.” Required input elements: Handwashing facility (any of the following: tap, water in a bucket with fitted tap, pitcher located inside maternity), sterile gloves (at least 5 pairs for health centers, 10 pairs for hospitals)

Birth assisted in a sterile manner to lower risk of endometrial and umbilical infections.

Early detection of adverse progression during stage 1 labor monitoring.

“Partograph use”

“Labor progression plotted on partograph in real time.” Required input elements: Partographs (at least 10 blank forms)

Routine monitoring of maternal and fetal well-being to detect abnormal labor progression during stage 1.

Timely access to key equipment to limit third delay during stage 2 birth assistance.

“Delivery equipment instantly accessible”

“Delivery instruments (e.g. sterile delivery kit) made directly accessible in delivery room prior to onset of stage 2 labor.” Required input elements: Delivery instruments (either: 2 sterile delivery kits, or: all following items: 4 blades, 4 clamps/ties, 2 needles & holders, 4 forceps)

Vaginal birth is assisted in an immediate manner, especially in case of fetal or maternal distress.

“Aspirator device instantly accessible”

Aspirator device made directly accessible in delivery room prior to onset of stage 2 labor. Required input elements: Aspirator device (either functional manual or electric vacuum aspirator)

Obstructed airway is managed in an immediate manner, especially in case of newborn asphyxia.

Prevention of postpartum hemorrhage during stage 3 birth management.

“Use of uterotonic”

Administration of uterotonic in beginning of stage 3. Required input elements: Oxytocin: at least 1 oxytocin injection.

Pharmacological prevention of postpartum bleeding during stage 3.

“Placenta completeness”

Once delivered, placenta is examined for completeness.

Postpartum bleeding as result of retained products is excluded.

Continuity of care during stage 4 immediate postpartum monitoring.

“Maternal monitoring”

Blood pressure, heart rate, uterus tone, and vaginal bleeding checked at least once during initial 2 h following childbirth.

Signs of postpartum bleeding continued to be monitored after childbirth.

“Newborn monitoring”

Breathing effort, temperature, general responsiveness checked at least once during initial 2 h following childbirth.

Signs of neonatal distress continued to be monitored after childbirth.