Challenges to implementation and suggested solutions
| Challenge | Solutions |
| Resistance to using the Checklist and a lack of staff motivation | Education, ongoing supervision and training specifically addressing knowledge gaps; Educating physicians and their supervisors on the importance and value of the Checklist |
| Lack of understanding on how to use the Checklist | Educating staff on how to use the Checklist, developing leaflets and other job aids |
| Perception of increased workload related to Checklist use | Education on the importance of the Checklist and essential practices |
| Limited Checklist supply | Working with management to develop a supply system; Identifying a leader responsible for ensuring supplies |
| Lack of essential birth supplies | Advising management to request the identified critical drugs/equipment; Implementers to conduct assessments and arrange provision of missing supplies |
| Inadequate staff including intermittent attendance | Focus on attendance; Encourage birth attendants to ask birth companions for assistance |
| Staff turnover | Conducting ongoing periodic training sessions |
| Care of women and newborns at different places in the facility | Splitting Checklist pause points into separate documents for each of the different sites for care |
| Forgetting to use the Checklist | Placing the Checklist in visible places; creating large posters for walls |
| Insufficient trained birth attendants to manage several women presenting in labour at the same time | Encouraging birth attendants to use birth companions for assistance |
| Inconsistencies with local and national guidelines | Adaptation/modification of the Checklist |
| Lack of clinical skills required by Checklist | Arranging trainings for essential birth practices |