Another very important observation of this study is that the partogram, recommended by the WHO, did not predict labor outcome. More than half of all deliveries in this study were diagnosed as having labor dystocia according to the partogram, whilst over 60% of them ended in a spontaneously vaginal delivery. Our reflection is that deliveries among primiparas may be different from how they were described by Friedman and his co-workers who created the partogram in the 1950s [18, 19]. Our message is that whilst the partogram is in every way an important tool for keeping records of activity during childbirth, it is not a useful predictor of delivery outcome [16–20].