Involving mothers in monitoring their unborn babies during labour: experience from Liberia

To assess the impact on perinatal mortality and morbidity of involving mothers in partnership with maternity staff in monitoring their unborn babies.

Mothers attending 4 hospitals in Liberia consented and were trained to use doppler ultrasound probes to monitor for abnormalities or changes in fetal heart rates during labour. A range of 120 to 160 beats per minute was chosen as normal. Intermittent auscultation was undertaken sequentially, immediately following the end of every uterine contraction.

One hundred eleven intrauterine fetal deaths occurred before mothers arrived. Of 6444 mothers with live fetuses at onset of monitoring, 12 (0.19%) delivered Intrapartum stillbirths with 10 having heart rate changes. There were 30 + 1 neonatal deaths (0.48%) including 20 with changes. 658 of the 6432 liveborn neonates (10%) received resuscitation. In this latter group, 360 of 488 (74%) with changes received resuscitation; 298 of 5946 (5%) without changes received resuscitation. 859 of 5948 (14.5%) without changes and 217 (44%) of 495 with changes were delivered by Caesarean section. Overall Caesarean section rate was 17%. Five-min Apgar scores were documented in 6432 newborns: 16 (0.25%), including 12 with changes, had scores of 1 or 2; 43 (0.67%), including 25 with changes had scores of 3 or 4; 149 (2.32%), including 82 with changes had scores of 5 or 6; 6216 (96.5%) had scores of 7 or more including 5866 (94.4%) without changes and 350 (5.6%) with changes. 5562 (95%) of the 5866 babies with no changes had scores of 10 while only 139 of 350 (40%) with changes had Apgar scores of 10. 340 of 6432 monitored had birth asphyxia (5.3%). Many fetuses had abnormal heart rates on arrival: 9 of 16 (56%) with Apgar's 1 or 2; 7 of 43 (16%) with Apgar's 3 or 4; 23 of 149 (15%) with Apgar's 5 or 6. Mothers' comments were mostly positive. Many expressed their empowerment by being included actively in the care of their unborn babies.

Compared with other low-resource countries, there were fewer intrapartum stillbirths, fewer neonatal deaths, and less birth asphyxia.