The Tragedy of Stillbirth in Nigeria: How Can Midwives Help?

<p><strong>Reducing the stillbirth rate is a global target. Recommendations for achieving it included intrapartum fetal heart monitoring and documentation practices using evidence-based guidelines. Non-compliance with the evidence-based guidelines by midwives, especially in low and middle-income countries, has been the focus of some studies on fetal heart monitoring, documentation, and stillbirth. Information is lacking on how midwives carry out intrapartum fetal heart monitoring, what barriers and facilitators exist to implementing evidence-based guidelines, and the need for context specific intervention plans to be developed. This study aims to reveal the barriers and facilitators to evidence-based fetal heart monitoring and documentation during labour and develop an action plan algorithm for implementing the standard practices for midwives in the Nigerian maternity system. Additionally, insight into the midwives' current knowledge of fetal heart monitoring and documentation practices during labour in the settings under study is provided.</strong></p><p>The data for this qualitative study, which used a Knowledge to Action Framework guided process, was collected through observations and semi-structured interviews with 15 midwives and focus group discussions with 15 stakeholders from the three levels (primary, secondary, and tertiary) of maternity care services in the southeastern region of Nigeria. The thematic analysis reveals limited knowledge of fetal heart monitoring and documentation guidelines and noncompliance with evidence-based recommendations in practice. Also, the impediments experienced by midwives included a lack of practice guidelines, facility-related issues, attitude, the experience of women in labour, lack of knowledge, and the attitude of midwives. In addition, the verbalised opportunities for improvement in practice include facility-related improvement, provision of guidelines and monitoring tools, maternity care quality and safety checks, midwives’ development programs, and available support for midwives. The midwives further outlined the prevalent causes of stillbirths in their settings as inadequate fetal monitoring and delayed interventions. The participants requested an implementation plan to foster the uptake of evidence-based knowledge into their practice. These findings indicate the midwives' role in stillbirth reduction. Thus, propose that midwives in this context can use the Action Plan Algorithm developed in this study to facilitate the implementation of evidence-based fetal heart monitoring and documentation practice to reduce the stillbirth rate.</p>