A study in a low income country describing the feasibility of mothers in labour monitoring the heart rates of their unborn babies

15 June, 2020

Dear Neil and Colleagues,

I thought you might like to see our paper on fetal monitoring by mothers during labour in Liberia which was published today in the open access journal BMC Pregnancy and Childbirth together with a blog by Dr Rhona MacDonald from MCAI.

Very low ratios of midwives to mothers in labour in maternity wards in low-resource settings, such as Liberia, often lead to high rates of birth asphyxia and intrapartum stillbirths due to a lack of fetal heart-rate monitoring.

Here is a selected summary of some of the results of this initiative:

“Four hundred sixty-one out of 474 women gave consent, of whom 431 of 461 (93%) completed the monitoring themselves. Three hundred eighty-seven of 400 women who gave comments, reported positive and 13 negative experiences. Fetal Heart Rate (FHR) changes were reported in 28 participants and confirmed in 26. Twenty-four of these 26 FHR changes were first identified by mothers. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes that were detected. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants”.

Compared with well-resourced countries, intrapartum related neonatal mortality rates are 25-fold higher and intrapartum stillbirth rates up to 50 times higher in the lowest-income countries where rehabilitation services for children with neuro-developmental impairments are poor or absent.

Here is a link to our paper: https://rdcu.be/b4UnP and a link to the blog: http://blogs.biomedcentral.com/bmcseriesblog/2020/06/15/listening-to-my-...

Best wishes

David

Professor David Southall OBE, MD, FRCPCH

Honorary Medical Director MCAI, 1 Columba Court, Laide IV22 2NL, UK

+44 (0) 7710 674003 and +44 (0)7944 632011

WhatsApp +44 7944 632011

www.mcai.org.uk, http://books.mcai.org.uk and www.ihpi.org

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Director, MCAI Liberia, Office within WHO in the UN One Building, and Field Office, House 13, Phebe Hospital, Liberia Enterprise Number 051730402

HIFA profile: David Southall is a retired Professor of Paediatrics and Honorary Medical Director of the Maternal and Child Health Advocacy International (MCAI). www.mcai.org.uk David founded MCAI in 1995 and currently is directing a task-sharing programme in Liberia aimed at the training of midwives in advanced obstetrics (including abdominal surgery) and the training of nurses and midwives in advanced neonatal care. David’s main interests include: medical education, approaches to healthcare based on human rights, sustained improvements in the emergency hospital care of pregnant women and adolescent girls, babies and children in disadvantaged countries, preventing the life-threatening abuse of children, and advocacy against armed conflict and the arms trade and its effects on mothers and children. director AT mcai.org.uk