An evaluation of fetal heart monitoring during labour for low-risk women in Samoa (Upolu)

Fetal heart monitoring (FHM) is an essential midwifery skill to determine fetal well-being and maternal characteristics during labour. Intermittent auscultation (IA) and Cardiotocography (CTG) are the two ways to perform fetal heart monitoring. IA is the suitable method to carry out fetal heart monitoring of low-risk women during labour, however, in Samoa, availability of resources (equipment and staff) in each hospital facilities influence fetal heart monitoring practice.

This research set out to explore the level of the clinical problem in Samoa. Informed by the science of Knowledge Translation, a sequential mixed methods observational study was employed to explore the research questions. This involved a medical record review at three Hospitals in Upolu, and semi structured interviews with midwives working in the same Hospitals.

Based on the findings, fetal heart monitoring is poorly translated into practice. Documentation of intermittent auscultation (duration, frequency, timing) in the first and second stage of labour was inadequate, and access to fetal heart monitoring equipment (Pinard stethoscope, hand-held Doppler devices, and cardiotocograph machines) was unequal in Upolu. The review of medical records indicated that the CTG transducer was utilised to monitor the fetal heart in 75% of cases within the tertiary referral system. On the other hand, the handheld Doppler was only used 14% of the time in two District Hospitals, with no documentation of Pinard usage.

From the interviews with midwives three core themes, 11 subthemes supporting the core themes, and one sub-sub theme emerged. Core themes were ‘Midwives’ knowledge, experiences, views, and practice’; ‘Resources and Risks’; and ‘Protocol and training’. The findings reflected poor translation of knowledge of intrapartum fetal heart monitoring for low-risk women.

This study is significant as it is the first of its kind to examine intrapartum fetal heart monitoring practices in the Pacific islands and sheds light on the knowledge, views, practices, and experiences of Samoa Midwives regarding fetal heart monitoring. The results of this study can contribute to research knowledge, influence important changes in midwifery care, and potentially improve maternal and neonatal outcomes in Samoa and the wider Pacific region.