Conclusion
Timely and high-quality obstetric emergency care such as caesarean
section significantly reduces maternal mortality and morbidity. While
Liberia has experienced increased facility-based deliveries in the past
decade, it has not been accompanied by timely referral to hospitals
capable of performing emergency obstetric services. Prior to
implementation of the MORES intervention, unidirectional communication
from RHFs to district hospitals prevented feedback to providers making
the referral. While the focus of this study was not to examine quality
improvement at RHFs, providing feedback to healthcare providers has the
potential to examine clinical decision-making in real time and increase
connectedness for providers working in rural settings. Given that the
MORES intervention was associated with a significant increase in CS and
a reduction in depressed newborns at birth, it may be an innovative
solution to communicate emergency referral information, improve
treatment upon arrival at the hospital, and improve bi-directional
communication to ultimately reduce maternal and newborn morbidity and
mortality. Future studies should examine the reasons for delays after
referral has been made as well as interventions to overcome these
challenges.