Dear Hifa colleagues,
I am really pleased to forward to you our latest "open access” publication.
Although undertaken in a very low resource country, the involvement and empowerment of mothers in one of the most important activities in their lives has, in our opinion, major relevance not only in all low- resource countries but to maternity care in the UK and other rich countries.
Here is the DOI: https://link.springer.com/article/10.1186/s12884-026-08951-3
Citation: MacDonald et al. BMC Pregnancy and Childbirth (2026) 26:564
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.
Full-text access to the enhanced PDF of our paper has been provided by BMC Pregnancy and Childbirth by using the following link: https://rdcu.be/fj7tD
It would be great if you could consider the development of this approach to reducing stillbirths, neonatal deaths and birth asphyxia in other countries. We are happy to do all we can to help with this.
With kindest regards
David Southall
Professor David Southall OBE, MD, FRCPCH
Consultant Obstetrician Liberia, Professor of Paediatrics UK and Visiting Professor, Odesa National Medical University, Ukraine
Honorary Medical Director Maternal and Childhealth Advocacy International (MCAI), 1 Columba Court, Laide IV22 2NL, UK
Mobile and WhatsApp numbers +44 (0) 7710 674003 and +44 (0)7944 632011
https://www.mcai.org.uk/
Registered as a SCIO (Scottish Charitable Incorporated Organisation) No. SC043467
Director, MCAI Liberia, Field Office, House 13, Phebe Hospital, Liberia Enterprise Number 051730402<tel: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