Int J Gynecol Obstet, 1992, 39: 117-122 International Federation of Gynecology and Obstetrics 117 The role of the village midwife in detection of high risk pregnancies and newborns S.A. Ibrahim”, M.I.A. Omera, I.K. Aminb, A.G. Babikerb and H. Rushwanc “ Department of Pediatrics, Faculty of Medicine, bSchool of Mathematical Sciences and ‘Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Khartoum, Khartoum (Sudan) (Received October 17th, 1991) (Revised and accepted February 2Oth, 1992) Abstract The preliminary findings of a prospective study of perinatal, neonatal and maternal mor- tality carried out in a rural community of Sudan are reported. Out of 6275 deliveries monitored over a period of 3 years, 150 stillbirths, 167 neonatal deaths and 27 maternal deaths were observed. An intervention program to upgrade the skills of the village midwives started in the middle of the second year. There was a 25% reduction in the risk of unfavorable outcome of pregnancy (i.e. stillbirth and neonatal death) in the third year relative to the $rst 2 years. Peer review of the 40 village mid- wives who took part in the study revealed their tremendous potentials in mobilization of mothers as well as participation in primary health care. Their role in detection of high risk pregnancies and newborns cannot be overem- phasized. Keywords Village midwife; High risk preg- nancy; Perinatal mortality; Maternal mortal- ity; Developing countries. Introduction In developing countries, village midwives attend most births. However, these are the deliveries which are associated with high 0020-7292/92/%05.00 Social Issues 0 1992 International Federation of Gynecology and Obstetrics Printed and Published in Ireland perinatal, neonatal and maternal mortality [lo]. In the Sudan, it is estimated that over one million births occur every year [9]; 140 000 infants die by the end of their tirst year and 3000-6000 mothers die as a result of pregnancy and childbirth [l]. The absence of an efficient system to obtain detailed relevant information and the always undervalued role of the village midwife (VM), have combined to hinder research on high risk pregnancies and newborns that could lead to prevention. The majority of births occur in rural areas inhabited by 85% of the Sudanese population [9]. Paradoxically, the health resources avail- able to them are poorly staffed, ill equipped, and lacking even life-saving drugs. Modest services which do exist are found in health centres (usually staffed by a doctor, medical assistants and nurses), dispensaries (with one medical assistant and a nurse) or dressing sta- tions (run by a nurse or VM). The village midwife is a woman, generally illiterate, nominated by her community to apply for special training. After 1 year in the midwifery school, she is registered and licens- ed to practice domiciliary midwifery in her area, ostensibly under the supervision of the rural health visitor (RHV), a qualified nurse midwife with additional preparation in management, planning and administration [Lgl. In this community-based prospective study,