title: Training of midwives in advanced obstetrics in Liberia.
abstract: OBJECTIVE
  The shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care.
  
  
  METHODS
  In a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts.
  
  
  METHODS
  The training took place in CB Dunbar Maternity Hospital. This rural hospital deals with approximately 2000 deliveries annually, many of which present complications. In February 2015 there were just 117 doctors available in Liberia.
  
  
  RESULTS
  In the first 18 months of training, the trainees were involved with 236 caesarean sections, 35 manual evacuations of products of conception, 25 manual removals of placentas, 21 vaginal breech deliveries, 14 vacuum deliveries, four repairs of ruptured uteri, the management of four cases of shoulder dystocia, three hysterectomies, two laparotomies for ruptured ectopic pregnancies and numerous obstetric ultrasound examinations. The trainees also managed 41 cases of eclampsia or severe pre-eclampsia, 25 of major postpartum haemorrhage and 21 of shock. Although, initially they only assisted senior doctors, the trainees subsequently progressed from direct to indirect supervision and then to independent management.
  
  
  CONCLUSIONS
  To compensate for a shortage of doctors able to undertake comprehensive emergency obstetric and neonatal care, experienced midwives can be taught to undertake advanced obstetric care and procedures. Their team work with doctors can be particularly valuable in rural hospitals in resource-poor countries.
authors.affiliation: CB Dunbar Maternity Hospital, Gbanga, Liberia .
authors.forename: Obed
authors.initials: O
authors.lastname: Dolo
authors.affiliation: Maternal and Childhealth Advocacy International, Brikama Major Health Centre, Brikama, Gambia .
authors.forename: Alice
authors.initials: A
authors.lastname: Clack
authors.affiliation: CB Dunbar Maternity Hospital, Gbanga, Liberia .
authors.forename: Hannah
authors.initials: H
authors.lastname: Gibson
authors.affiliation: CB Dunbar Maternity Hospital, Gbanga, Liberia .
authors.forename: Naomi
authors.initials: N
authors.lastname: Lewis
authors.affiliation: Maternal and Childhealth Advocacy International, 1 Columba Court, Laide, IV22 2NL, Scotland .
authors.forename: David P
authors.initials: DP
authors.lastname: Southall
mesh_terms: D005260:Female; D006801:Humans; D007988:Liberia; D008880:Midwifery / Q000193:education*; D009774:Obstetrics; D010820:Physicians / Q000600:supply & distribution