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

AIM: To assess the impact on perinatal mortality and morbidity of involving mothers in partnership with maternity staff in monitoring their unborn babies. METHODS: 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. RESULTS: 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. CONCLUSIONS: Compared with other low-resource countries, there were fewer intrapartum stillbirths, fewer neonatal deaths, and less birth asphyxia.