Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Care | Research article

Perceptions and experiences of skilled birth attendants on using a newly developed strap-on electronic fetal heart rate monitor in Tanzania

Authors: Sara Rivenes Lafontan, Hussein L. Kidanto, Hege L. Ersdal, Columba K. Mbekenga, Johanne Sundby

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

Login to get access

Abstract

Background

Regular fetal heart rate monitoring during labor can drastically reduce fresh stillbirths and neonatal mortality through early detection and management of fetal distress. Fetal monitoring in low-resource settings is often inadequate. An electronic strap-on fetal heart rate monitor called Moyo was introduced in Tanzania to improve intrapartum fetal heart rate monitoring. There is limited knowledge about how skilled birth attendants in low-resource settings perceive using new technology in routine labor care. This study aimed to explore the attitude and perceptions of skilled birth attendants using Moyo in Dar es Salaam, Tanzania.

Methods

A qualitative design was used to collect data. Five focus group discussions and 10 semi-structured in-depth interviews were carried out. In total, 28 medical doctors and nurse/midwives participated in the study. The data was analyzed using qualitative content analysis.

Results

The participants in the study perceived that the device was a useful tool that made it possible to monitor several laboring women at the same time and to react faster to fetal distress alerts. It was also perceived to improve the care provided to the laboring women. Prior to the introduction of Moyo, the participants described feeling overwhelmed by the high workload, an inability to adequately monitor each laboring woman, and a fear of being blamed for negative fetal outcomes. Challenges related to use of the device included a lack of adherence to routines for use, a lack of clarity about which laboring women should be monitored continuously with the device, and misidentification of maternal heart rate as fetal heart rate.

Conclusion

The electronic strap-on fetal heart rate monitor, Moyo, was considered to make labor monitoring easier and to reduce stress. The study findings highlight the importance of ensuring that the device’s functions, its limitations and its procedures for use are well understood by users.
Appendix
Available only for authorised users
Literature
1.
go back to reference Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016;4(2):e98–e108.CrossRef Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016;4(2):e98–e108.CrossRef
2.
go back to reference Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9947):957–79.CrossRef Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9947):957–79.CrossRef
3.
go back to reference Ersdal HL, Eilevstjonn J, Linde JE, Yeconia A, Mduma ER, Kidanto H, et al. Fresh stillborn and severely asphyxiated neonates share a common hypoxic-ischemic pathway. Int J Gynaecol Obstet. 2018;141(2):171–80.CrossRef Ersdal HL, Eilevstjonn J, Linde JE, Yeconia A, Mduma ER, Kidanto H, et al. Fresh stillborn and severely asphyxiated neonates share a common hypoxic-ischemic pathway. Int J Gynaecol Obstet. 2018;141(2):171–80.CrossRef
4.
go back to reference United Nations Inter-agency Group for Child Mortality E. Levels and Trends in Child Mortality, Report 2017. UNICEF,World Health Organization, World Bank Group, United Nations; 2017. United Nations Inter-agency Group for Child Mortality E. Levels and Trends in Child Mortality, Report 2017. UNICEF,World Health Organization, World Bank Group, United Nations; 2017.
5.
go back to reference Ersdal HL, Mduma E, Svensen E, Perlman J. Birth asphyxia: a major cause of early neonatal mortality in a Tanzanian rural hospital. Pediatrics. 2012;129(5):e1238–43.CrossRef Ersdal HL, Mduma E, Svensen E, Perlman J. Birth asphyxia: a major cause of early neonatal mortality in a Tanzanian rural hospital. Pediatrics. 2012;129(5):e1238–43.CrossRef
6.
go back to reference Langli Ersdal H, Mduma E, Svensen E, Sundby J, Perlman J. Intermittent detection of fetal heart rate abnormalities identify infants at greatest risk for fresh stillbirths, birth asphyxia, neonatal resuscitation, and early neonatal deaths in a limited-resource setting: a prospective descriptive observational study at Haydom Lutheran hospital. Neonatology. 2012;102(3):235–42.CrossRef Langli Ersdal H, Mduma E, Svensen E, Sundby J, Perlman J. Intermittent detection of fetal heart rate abnormalities identify infants at greatest risk for fresh stillbirths, birth asphyxia, neonatal resuscitation, and early neonatal deaths in a limited-resource setting: a prospective descriptive observational study at Haydom Lutheran hospital. Neonatology. 2012;102(3):235–42.CrossRef
7.
go back to reference Gans-Lartey F, O'Brien BA, Gyekye FO, Schopflocher D. The relationship between the use of the partograph and birth outcomes at Korle-Bu teaching hospital. Midwifery. 2013;29(5):461–7.CrossRef Gans-Lartey F, O'Brien BA, Gyekye FO, Schopflocher D. The relationship between the use of the partograph and birth outcomes at Korle-Bu teaching hospital. Midwifery. 2013;29(5):461–7.CrossRef
8.
go back to reference Kidanto H, Msemo G, Mmbando D, Rusibamayila N, Ersdal H, Perlman J. Predisposing factors associated with stillbirth in Tanzania. Int J Gynaecol Obstet. 2015;130(1):70–3.CrossRef Kidanto H, Msemo G, Mmbando D, Rusibamayila N, Ersdal H, Perlman J. Predisposing factors associated with stillbirth in Tanzania. Int J Gynaecol Obstet. 2015;130(1):70–3.CrossRef
9.
go back to reference Wyatt J. Appropriate medical technology for perinatal care in low-resource countries. Ann Trop Paediatr. 2008;28(4):243–51.CrossRef Wyatt J. Appropriate medical technology for perinatal care in low-resource countries. Ann Trop Paediatr. 2008;28(4):243–51.CrossRef
10.
go back to reference Rivenes Lafontan S, Sundby J, Ersdal HL, Abeid M, Kidanto HL, Mbekenga CK. "I was relieved to know that my baby was safe": Women's attitudes and perceptions on using a new electronic fetal heart rate monitor during labor in Tanzania. Int J Environ Res Public Health. 2018;15(2). Rivenes Lafontan S, Sundby J, Ersdal HL, Abeid M, Kidanto HL, Mbekenga CK. "I was relieved to know that my baby was safe": Women's attitudes and perceptions on using a new electronic fetal heart rate monitor during labor in Tanzania. Int J Environ Res Public Health. 2018;15(2).
11.
go back to reference Mahomed K, Nyoni R, Mulambo T, Kasule J, Jacobus E. Randomised controlled trial of intrapartum fetal heart rate monitoring. Bmj. 1994;308(6927):497–500.CrossRef Mahomed K, Nyoni R, Mulambo T, Kasule J, Jacobus E. Randomised controlled trial of intrapartum fetal heart rate monitoring. Bmj. 1994;308(6927):497–500.CrossRef
12.
go back to reference Kamala BA, Kidanto HL, Wangwe PJ, Dalen I, Mduma ER, Perlman JM, et al. Intrapartum fetal heart rate monitoring using a handheld Doppler versus Pinard stethoscope: a randomized controlled study in Dar Es Salaam. Int J Women's Health. 2018;10:341–8.CrossRef Kamala BA, Kidanto HL, Wangwe PJ, Dalen I, Mduma ER, Perlman JM, et al. Intrapartum fetal heart rate monitoring using a handheld Doppler versus Pinard stethoscope: a randomized controlled study in Dar Es Salaam. Int J Women's Health. 2018;10:341–8.CrossRef
13.
go back to reference Ayres-de-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet. 2015;131(1):13–24.CrossRef Ayres-de-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet. 2015;131(1):13–24.CrossRef
14.
go back to reference World Health Organization partograph in management of labour. World Health Organization Maternal Health and Safe Motherhood Programme. 1994. World Health Organization partograph in management of labour. World Health Organization Maternal Health and Safe Motherhood Programme. 1994.
15.
go back to reference Housseine N, Punt MC, Browne JL, ‘t Hooft J, Maaløe N, Meguid T, Theron GB, Franx A, Grobbee DE, Visser GH, Rijken MJ. Delphi consensus statement on intrapartum fetal monitoring in low‐resource settings. Int J Gynecol Obstet. 2019. https://doi.org/10.1002/ijgo.12724. Housseine N, Punt MC, Browne JL, ‘t Hooft J, Maaløe N, Meguid T, Theron GB, Franx A, Grobbee DE, Visser GH, Rijken MJ. Delphi consensus statement on intrapartum fetal monitoring in low‐resource settings. Int J Gynecol Obstet. 2019. https://​doi.​org/​10.​1002/​ijgo.​12724.
16.
go back to reference Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2017;2:Cd006066.PubMed Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2017;2:Cd006066.PubMed
17.
go back to reference Mdoe PF, Ersdal HL, Mduma E, Moshiro R, Dalen I, Perlman JM, et al. Randomized controlled trial of continuous Doppler versus intermittent fetoscope fetal heart rate monitoring in a low-resource setting. Int J Gynaecol Obstet. 2018. Mdoe PF, Ersdal HL, Mduma E, Moshiro R, Dalen I, Perlman JM, et al. Randomized controlled trial of continuous Doppler versus intermittent fetoscope fetal heart rate monitoring in a low-resource setting. Int J Gynaecol Obstet. 2018.
18.
go back to reference Mdoe PF, Ersdal HL, Mduma E, Moshiro R, Kidanto H, Mbekenga C. Midwives' perceptions on using a fetoscope and Doppler for fetal heart rate assessments during labor: a qualitative study in rural Tanzania. BMC Pregnancy Childbirth. 2018;18(1):103.CrossRef Mdoe PF, Ersdal HL, Mduma E, Moshiro R, Kidanto H, Mbekenga C. Midwives' perceptions on using a fetoscope and Doppler for fetal heart rate assessments during labor: a qualitative study in rural Tanzania. BMC Pregnancy Childbirth. 2018;18(1):103.CrossRef
19.
go back to reference Rivenes Lafontan S, Sundby J, Kidanto HL, Mbekenga CK, Ersdal HL. Acquiring knowledge about the use of a newly developed electronic fetal heart rate monitor: a qualitative study among birth attendants in Tanzania. Int J Environ Res Public Health. 2018;15(12). Rivenes Lafontan S, Sundby J, Kidanto HL, Mbekenga CK, Ersdal HL. Acquiring knowledge about the use of a newly developed electronic fetal heart rate monitor: a qualitative study among birth attendants in Tanzania. Int J Environ Res Public Health. 2018;15(12).
20.
go back to reference Litorp H, Kidanto HL, Nystrom L, Darj E, Essen B. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth. 2013;13:107.CrossRef Litorp H, Kidanto HL, Nystrom L, Darj E, Essen B. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth. 2013;13:107.CrossRef
21.
go back to reference Mgaya AH, Litorp H, Kidanto HL, Nystrom L, Essen B. Criteria-based audit to improve quality of care of foetal distress: standardising obstetric care at a national referral hospital in a low resource setting, Tanzania. BMC Pregnancy Childbirth. 2016;16(1):343.CrossRef Mgaya AH, Litorp H, Kidanto HL, Nystrom L, Essen B. Criteria-based audit to improve quality of care of foetal distress: standardising obstetric care at a national referral hospital in a low resource setting, Tanzania. BMC Pregnancy Childbirth. 2016;16(1):343.CrossRef
22.
go back to reference Litorp H, Kidanto HL, Roost M, Abeid M, Nystrom L, Essen B. Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania. BMC Pregnancy Childbirth. 2014;14:244.CrossRef Litorp H, Kidanto HL, Roost M, Abeid M, Nystrom L, Essen B. Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania. BMC Pregnancy Childbirth. 2014;14:244.CrossRef
23.
go back to reference Green J, Thorogood N. Qualitative methods for health research. 2nd ed. ed. London: Sage; 2009. Green J, Thorogood N. Qualitative methods for health research. 2nd ed. ed. London: Sage; 2009.
24.
go back to reference Graneheim UH, Lindgren BM, Lundman B. Methodological challenges in qualitative content analysis: a discussion paper. Nurse Educ Today. 2017;56:29–34.CrossRef Graneheim UH, Lindgren BM, Lundman B. Methodological challenges in qualitative content analysis: a discussion paper. Nurse Educ Today. 2017;56:29–34.CrossRef
25.
go back to reference Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRef Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRef
26.
go back to reference Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, et al. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: a systematic review. Gates Open Res. 2018;2:4.CrossRef Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, et al. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: a systematic review. Gates Open Res. 2018;2:4.CrossRef
27.
go back to reference Mugyenyi GR, Atukunda EC, Ngonzi J, Boatin A, Wylie BJ, Haberer JE. Functionality and acceptability of a wireless fetal heart rate monitoring device in term pregnant women in rural southwestern Uganda. BMC Pregnancy Childbirth. 2017;17(1):178.CrossRef Mugyenyi GR, Atukunda EC, Ngonzi J, Boatin A, Wylie BJ, Haberer JE. Functionality and acceptability of a wireless fetal heart rate monitoring device in term pregnant women in rural southwestern Uganda. BMC Pregnancy Childbirth. 2017;17(1):178.CrossRef
28.
go back to reference Agha S. The impact of a quality-improvement package on reproductive health services delivered by private providers in Uganda. Stud Fam Plan. 2010;41(3):205–15.CrossRef Agha S. The impact of a quality-improvement package on reproductive health services delivered by private providers in Uganda. Stud Fam Plan. 2010;41(3):205–15.CrossRef
29.
go back to reference Litorp H, Mgaya A, Mbekenga CK, Kidanto HL, Johnsdotter S, Essen B. Fear, blame and transparency: obstetric caregivers' rationales for high caesarean section rates in a low-resource setting. Soc Sci Med. 2015;143:232–40.CrossRef Litorp H, Mgaya A, Mbekenga CK, Kidanto HL, Johnsdotter S, Essen B. Fear, blame and transparency: obstetric caregivers' rationales for high caesarean section rates in a low-resource setting. Soc Sci Med. 2015;143:232–40.CrossRef
30.
go back to reference Mdoe PF, Ersdal HL, Mduma ER, Perlman JM, Moshiro R, Wangwe PT, et al. Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial. BMC Pregnancy Childbirth. 2018;18(1):134.CrossRef Mdoe PF, Ersdal HL, Mduma ER, Perlman JM, Moshiro R, Wangwe PT, et al. Intermittent fetal heart rate monitoring using a fetoscope or hand held Doppler in rural Tanzania: a randomized controlled trial. BMC Pregnancy Childbirth. 2018;18(1):134.CrossRef
31.
go back to reference Byaruhanga R, Bassani DG, Jagau A, Muwanguzi P, Montgomery AL, Lawn JE. Use of wind-up fetal Doppler versus Pinard for fetal heart rate intermittent monitoring in labour: a randomised clinical trial. BMJ Open. 2015;5(1):e006867.CrossRef Byaruhanga R, Bassani DG, Jagau A, Muwanguzi P, Montgomery AL, Lawn JE. Use of wind-up fetal Doppler versus Pinard for fetal heart rate intermittent monitoring in labour: a randomised clinical trial. BMJ Open. 2015;5(1):e006867.CrossRef
32.
go back to reference Combs Thorsen V, Sundby J, Meguid T, Malata A. Easier said than done!: methodological challenges with conducting maternal death review research in Malawi. BMC Med Res Methodol. 2014;14:29.CrossRef Combs Thorsen V, Sundby J, Meguid T, Malata A. Easier said than done!: methodological challenges with conducting maternal death review research in Malawi. BMC Med Res Methodol. 2014;14:29.CrossRef
33.
go back to reference Heemelaar S, Nelissen E, Mdoe P, Kidanto H, van Roosmalen J, Stekelenburg J. Criteria-based audit of caesarean section in a referral hospital in rural Tanzania. Tropical Med Int Health. 2016;21(4):525–34.CrossRef Heemelaar S, Nelissen E, Mdoe P, Kidanto H, van Roosmalen J, Stekelenburg J. Criteria-based audit of caesarean section in a referral hospital in rural Tanzania. Tropical Med Int Health. 2016;21(4):525–34.CrossRef
34.
go back to reference National Academies of Sciences E, Medicine, health, medicine D, board on health care S, board on global H, et al. the National Academies Collection: reports funded by National Institutes of Health. Crossing the global quality chasm: improving health care worldwide. Washington (DC): National Academies Press (US) copyright 2018 by the National Academy of Sciences. All rights reserved. 2018. National Academies of Sciences E, Medicine, health, medicine D, board on health care S, board on global H, et al. the National Academies Collection: reports funded by National Institutes of Health. Crossing the global quality chasm: improving health care worldwide. Washington (DC): National Academies Press (US) copyright 2018 by the National Academy of Sciences. All rights reserved. 2018.
35.
go back to reference Editorial. Universal health coverage post-2015: putting people first. Lancet. 2014;384(9960):2083. Editorial. Universal health coverage post-2015: putting people first. Lancet. 2014;384(9960):2083.
36.
go back to reference Maaloe N, Housseine N, Meguid T, Nielsen BB, Jensen A, Khamis RS, et al. Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi-experimental pre-post study (the PartoMa study). BJOG. 2018;125(2):235–45.CrossRef Maaloe N, Housseine N, Meguid T, Nielsen BB, Jensen A, Khamis RS, et al. Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi-experimental pre-post study (the PartoMa study). BJOG. 2018;125(2):235–45.CrossRef
37.
go back to reference Maaloe N, Housseine N, van Roosmalen J, Bygbjerg IC, Tersbol BP, Khamis RS, et al. Labour management guidelines for a Tanzanian referral hospital: the participatory development process and birth attendants' perceptions. BMC Pregnancy Childbirth. 2017;17(1):175.CrossRef Maaloe N, Housseine N, van Roosmalen J, Bygbjerg IC, Tersbol BP, Khamis RS, et al. Labour management guidelines for a Tanzanian referral hospital: the participatory development process and birth attendants' perceptions. BMC Pregnancy Childbirth. 2017;17(1):175.CrossRef
38.
go back to reference Murray ML. Maternal or fetal heart rate? Avoiding intrapartum misidentification. J Obstet Gynecol Neonatal Nurs. 2004;33(1):93–104.CrossRef Murray ML. Maternal or fetal heart rate? Avoiding intrapartum misidentification. J Obstet Gynecol Neonatal Nurs. 2004;33(1):93–104.CrossRef
39.
go back to reference Lewis D, Downe S. Panel FIFMEC. FIGO consensus guidelines on intrapartum fetal monitoring: intermittent auscultation. Int J Gynaecol Obstet. 2015;131(1):9–12.CrossRef Lewis D, Downe S. Panel FIFMEC. FIGO consensus guidelines on intrapartum fetal monitoring: intermittent auscultation. Int J Gynaecol Obstet. 2015;131(1):9–12.CrossRef
40.
go back to reference Ahman A, Edvardsson K, Lesio Kidanto H, Ngarina M, Small R, Mogren I. 'Without ultrasound you can't reach the best decision' - Midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania. Sex Reprod Healthc. 2018;15:28–34.CrossRef Ahman A, Edvardsson K, Lesio Kidanto H, Ngarina M, Small R, Mogren I. 'Without ultrasound you can't reach the best decision' - Midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania. Sex Reprod Healthc. 2018;15:28–34.CrossRef
41.
go back to reference Moen K, Middelthon A-L. Qualitative research methods. Research in medical and biological sciences: Elsevier Ltd; 2015. p. 321–78.CrossRef Moen K, Middelthon A-L. Qualitative research methods. Research in medical and biological sciences: Elsevier Ltd; 2015. p. 321–78.CrossRef
42.
go back to reference Rickham PP. Human Experimentation. Code of ethics of the world medical association. Declaration of Helsinki. Br Med J. 1964;2(5402):177.CrossRef Rickham PP. Human Experimentation. Code of ethics of the world medical association. Declaration of Helsinki. Br Med J. 1964;2(5402):177.CrossRef
Metadata
Title
Perceptions and experiences of skilled birth attendants on using a newly developed strap-on electronic fetal heart rate monitor in Tanzania
Authors
Sara Rivenes Lafontan
Hussein L. Kidanto
Hege L. Ersdal
Columba K. Mbekenga
Johanne Sundby
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2286-7

Other articles of this Issue 1/2019

BMC Pregnancy and Childbirth 1/2019 Go to the issue