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Introduction

There are approximately 4 million stillbirths and 4 million deaths in the first week of life worldwide each year. Most fresh stillbirths and many of these early neonatal deaths are caused by the fetus receiving too little oxygen during labour. These infants have usually grown well and thrived during pregnancy, only to die or suffer serious brain damage during the few hours of labour. The aim of fetal monitoring during labour is to identify these infants as soon as they start to become stressed due to insufficient oxygen, so that labour and delivery can be actively managed in order to deliver a healthy infant.

Three essentials are needed to care for infants safely during labour. Firstly, appropriate equipment to monitor the wellbeing of the infant during labour; secondly, a good understanding of the processes of labour and how to correctly manage these women; and thirdly, an efficient and adequately funded health service with well-integrated systems of communication, transport, staffing and management.

The commonly used Pinard fetal stethoscope is unfortunately not reliable as the fetal heart rate often cannot be heard well and accurately counted, especially in obese women, while a cardiotocograph (CTG) is expensive and needs a reliable electricity source, supply of paper, and expertise to read the tracings. In contrast, the prize-winning windup Doppler ultrasound fetal heart rate monitor, originally designed by Power-free Education and Technology (PET) and brought to market by Philips, is robust, easy to use, displays the fetal heart rate accurately, and is not dependent on mains electricity or replaceable batteries. It is ideal for primary care clinics in under-resourced regions as well as being very useful in hospitals. These fetal monitors can be ordered from the local supplier of Philips equipment or from www.philips.com.

The Perinatal Education Programme (PEP) has developed a range of self-managed learning courses for midwives, nurses and doctors who care for women during pregnancy and labour. The PEP course books are regularly updated and can be used for the continuing training of healthcare professionals. The contents of this handbook are taken from PEP course books. All of the PEP self-help learning books are published by Bettercare and can be obtained from www.bettercare.co.za.

This fetal heart rate handbook, which accompanies the wind-up fetal monitor, aims to provide a simple self-directed learning course in fetal monitoring. Using a simple question-and-answer format, it teaches the basic principles of oxygen transfer from mother to fetus, monitoring the fetus in labour, and recognising patterns of fetal heart rate in order to detect a fetus who is stressed due to inadequate oxygenation.

Note
Further, non-essential information for advanced midwives and doctors is provided for interest in notes like this.

Important practical lessons are highlighted in boxes like this.

A combination of good monitoring of all women in labour, together with well-trained healthcare workers, promises to reduce perinatal mortality and ensure healthy infants at birth.