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

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.