Practices and Challenges in Foetal Heart Rate Monitoring: A Case Study of a County Referral Hospital in Kenya

Abstract

Background of the study

Inadequate monitoring of foetal heart rate has resulted in undesired outcomes during delivery. It has contributed to perinatal mortalities resulting from birth asphyxia.

Purpose

The study aimed at identifying gaps involved in monitoring foetal heart rate, with the sole purpose of improving practice and reducing cases of perinatal mortality from birth asphyxia.

Design

The study used a descriptive cross-sectional study design utilizing a mixed-method approach. A simple random sampling method was used to select 127 medical records, whilst a convenience sampling method was used to recruit 17 midwives. The study focused on women who had delivered in January 2023. Data were collected using a data abstraction form, an observation checklist, and a structured interview guide. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using the thematic method with an inductive approach.

Results

Based on direct observation, 100 % of women were monitored for foetal heart rate. However, the frequency and timing of monitoring were inconsistent. Most women (46 %) were monitored four times, 36 % twice, and 18 % once, with monitoring intervals ranging from 30 min to 4 h. Monitoring occurred primarily during active labour (88 %), with no monitoring observed in the second stage. In contrast, review of medical records revealed that only 70.1 % of women had documented evidence of foetal heart rate monitoring. Observed challenges included inadequate staffing, poor documentation practices, non-adherence to the monitoring schedule, cultural preferences, women’s unwillingness to be auscultated, peer pressure during delivery, lack of accountability, and assumptions by the midwives.

Conclusion

The practice of foetal heart rate monitoring at the County Referral Hospital falls short of the international standards. The inadequacy is evident in the inconsistency in monitoring, particularly among the women in the latent phase of the first stage of labour and those in the second stage. This gap is due to challenges existing at the facility, which include inadequate staffing, documentation challenges, non-adherence to the monitoring schedule, cultural preferences, unwillingness of the women to be auscultated, peer pressure during delivery, lack of accountability and assumptions by the midwives.