Fetal heart rate monitoring: the challenge in under-resourced settings

Background:

Intrapartum-related deaths are the second most common cause of neonatal death, resulting in 1.2 million stillbirths each year, many of which could be prevented with improved intrapartum monitoring. The partograph was developed as a tool to help health professionals to provide better and more efficient care during labour. This study set out to address whether this low-cost tool was reaching under-resourced settings and whether it was being used correctly.

Aim:

To assess barriers and enablers for the use of a partograph in under-resourced settings, especially to monitor fetal heart rate.

Method:

Evaluation of 538 partographs as well as in-depth interviews and knowledge assessments with 24 midwives.

Findings:

The general score for partograph use and completion was 59.3%. The score for fetal heart rate assessment was 56%. The midwives interviewed felt that partograph use and fetal heart rate monitoring were important but also felt insecure and undertrained in this aspect of midwifery practice.

Conclusions:

This review showed that very few partographs were completed according to standard, despite the fact that the midwives knew the importance of fetal heart rate monitoring and were motivated to monitor well. Time constraints and a lack of training were identified as the biggest barriers to correct monitoring.