Effective Strategies for Enhanced Maternal Care in Ukraine

Impact of War on Maternity Services in Ukraine

Since the onset of the Russian invasion of Ukraine, the functioning of maternity and neonatal units has been severely compromised. Disruptions in healthcare infrastructure due to shelling, large-scale population displacements, and shortages of qualified healthcare professionals have posed significant challenges to the provision of maternal care. The situation is exacerbated by targeted interruptions to electricity supplies, which hinder the use of essential medical equipment. Pregnant women face heightened anxiety, especially when separated from their partners, who may be engaged in combat. This stress can lead to adverse health outcomes, particularly during labor and delivery.

The Ukrainian healthcare system, prior to the war, was aligned with World Health Organization (WHO) recommendations for maternity care, which included fetal heart rate (FHR) monitoring protocols. However, the war has made it difficult to adhere to these protocols consistently. The ongoing conflict poses risks of fetal distress, complicating the already challenging landscape of maternal care (Maternal and Child Advocacy International, 2024).

Challenges in Monitoring Fetal Heart Rate During Conflict

The existing national protocols for intrapartum fetal heart rate monitoring in Ukraine are based on NICE guidelines and WHO recommendations. Regular auscultation of fetal heart rates is essential for identifying potential complications during labor. However, the war has made traditional monitoring methods increasingly difficult. For instance, when missile attacks occur, both medical staff and women in labor must move to bomb shelters, disrupting ongoing monitoring processes.

The protocol traditionally requires intermittent auscultation using either a Pinard stethoscope or a handheld Doppler device. Unfortunately, continuous monitoring via cardiotocography (CTG) is not standard practice in Ukraine, primarily due to resource constraints. This limitation raises the stakes for maternal and fetal outcomes, as adverse fetal heart rate patterns may go undetected (Maternal and Child Advocacy International, 2024).

Role of Maternal Involvement in Fetal Health Surveillance

To bridge the gap created by the ongoing conflict, a program has been initiated to engage mothers and their partners in self-monitoring of fetal heart rates during labor. This approach has been inspired by successful implementations in low-resource settings, such as Liberia. By empowering mothers to participate actively in monitoring their fetal health, the initiative aims to enhance the overall quality of perinatal care and mitigate the risks associated with fetal distress.

Mothers receive training on using battery-operated FHR Doppler ultrasound probes to monitor fetal heart rates after each uterine contraction. This “contraction-by-contraction” approach not only provides mothers with a sense of control and reassurance but can also facilitate earlier detection of fetal distress. Data from this program have shown that maternal self-monitoring can effectively complement existing monitoring practices conducted by healthcare staff (Maternal and Child Advocacy International, 2024).

Enhancements in Perinatal Care through Humanitarian Aid

With support from the Ministry of Health of Ukraine, humanitarian aid has been instrumental in maintaining the quality of perinatal care during the war. This aid includes the provision of essential equipment, drugs, and supplies to 61 maternity hospitals across the country. The distribution of battery-operated ultrasound scanners has significantly improved the ability of healthcare providers to diagnose and manage potential complications during labor, even amidst power outages.

The successful implementation of this program has resulted in the widespread use of portable ultrasound devices, allowing for on-site assessments that avoid the risks associated with transporting mothers to other facilities for ultrasound examinations. This adaptability is crucial in a war-torn environment where time and safety are paramount for both mother and child (Maternal and Child Advocacy International, 2024).

Table 1: Key Program Outcomes

Outcomes of Contraction-by-Contraction Monitoring by Mothers

The program’s data indicate that maternal involvement in FHR monitoring correlates with improved outcomes for both mothers and their infants. In instances where mothers participated in monitoring, there was a significant reduction in the rates of cesarean sections performed due to fetal distress. The joint approach to monitoring—where mothers and healthcare staff collaborate—has led to better identification of fetal well-being and a more proactive response to potential complications.

The ability of mothers to recognize changes in fetal heart rates has been validated, with studies showing that approximately 87% of changes identified by mothers were confirmed by medical staff. This level of involvement not only enhances maternal confidence but also fosters a collaborative healthcare environment that is particularly beneficial in crisis situations (Maternal and Child Advocacy International, 2024).

Future Directions for Improving Maternity Care in Crisis Situations

Looking ahead, it is critical to establish sustainable models of maternal care that can adapt to ongoing and future crises. Continued training for mothers in fetal health monitoring can be pivotal in ensuring that quality care is maintained, even in the face of adversity. Additionally, integrating technology with traditional practices may enhance the resilience of healthcare systems in war-torn regions.

Investment in telemedicine and mobile health solutions could further empower mothers by providing remote access to healthcare professionals for guidance during labor. Furthermore, ongoing evaluation of the program’s effectiveness will be essential to refine protocols and improve maternal and neonatal outcomes continuously.

FAQ Section

How can mothers participate in fetal heart rate monitoring during labor?
Mothers can use portable FHR Doppler ultrasound probes to monitor their baby’s heart rate following each contraction, with training provided by healthcare staff.

What is the importance of monitoring fetal heart rates during labor?
Monitoring fetal heart rates is crucial for detecting potential distress, which can lead to timely interventions and improve outcomes for both mother and baby.

How has humanitarian aid improved maternity care in Ukraine?
Humanitarian aid has provided essential equipment and supplies to maternity hospitals, enabling healthcare providers to maintain high standards of care despite the challenging conditions.

What are the potential benefits of joint monitoring by mothers and staff?
Joint monitoring can lead to earlier detection of fetal distress, reduced rates of unnecessary cesarean sections, and improved confidence among mothers regarding their baby’s well-being.

What are the next steps for improving maternal health in crisis situations?
Future efforts should focus on sustainable training for mothers, integrating technology into care practices, and continuous evaluation of healthcare protocols.

References

1. Maternal and Child Advocacy International. (2024). A descriptive analysis of a medical humanitarian aid initiative for quality perinatal management in war-torn Ukraine. Retrieved from https://doi.org/10.1186/s13031-025-00644-6
2. Liao, X. (2025). Deep brain stimulation of the hypothalamic region: a systematic review. Acta Neurochirurgica. Retrieved from https://doi.org/10.1007/s00701-025-06430-w
3. Kellogg, J. A., Monsivais, P., Murphy, K. M., and Perrigue, M. M. (2025). High β-Glucan Whole Grain Barley Reduces Postprandial Glycemic Response in Healthy Adults—Part One of a Randomized Controlled Trial. Nutrients. Retrieved from https://doi.org/10.3390/nu17030430