Peer-reviewed article
Involving mothers in monitoring their unborn babies during labour: experience from Liberia.
MacDonald R, Dahn B, Benson A, Fofana J, Kendema CF et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study involved mothers in Liberia in monitoring their babies' heart rates during labour using doppler ultrasound, alongside standard maternity care. Among over 6,400 mothers, the programme identified fetuses with abnormal heart rates, which correlated with poor newborn outcomes like low Apgar scores and need for resuscitation. Intrapartum stillbirth rates were low compared to other low-resource countries, and mothers reported feeling empowered by their involvement in monitoring.
Key points
- Of 6,444 mothers with live fetuses at monitoring onset, only 12 (0.19%) had intrapartum stillbirths, with 10 showing heart rate changes
- Neonatal death rate was 0.48% (31 deaths), with 20 of these babies showing heart rate changes during labour
- Fetuses with detected heart rate abnormalities were 14 times more likely to need resuscitation (74% vs 5%) and 3 times more likely to be delivered by Caesarean section (44% vs 14.5%)
- Babies with no detected heart rate changes had much better Apgar scores at 5 minutes (95% scored 10) compared to those with changes (40% scored 10)
- Mothers reported positive experiences and felt empowered by being actively involved in monitoring their unborn babies
Limitations
The document does not include a comparison group or control arm, so we cannot determine what outcomes would have been without maternal involvement. The study also does not specify the training duration, quality of implementation across sites, or potential harms from the intervention.
Abstract
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.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Training mothers to use doppler ultrasound probes to monitor fetal heart rates during labour in partnership with maternity staff, with normal range defined as 120-160 beats per minute
- Population
- 6,444 mothers with live fetuses at onset of monitoring attending 4 hospitals in Liberia
Key finding
Intrapartum stillbirth rate was 0.19% (12 of 6,444), with 83% (10 of 12) showing detected heart rate changes