It is gratifying to have been asked to produce a third edition of this

book. In 1992, with the fi rst edition, we felt we were rather lone

voices. Happily there have been developments in service provision,

education and training that now complement our objectives. Litigation

and complaint remain major issues, with the challenges that

these bring. The messages remain the same. The Fourth Confi dential

Enquiry into Stillbirths and Deaths in Infancy (CESDI)1 highlighted that

50% of intrapartum fetal deaths of those above 1500 gm with no

chromosomal or congenital malformations could have been avoided.

The main avoidable factors that were identifi ed were inability to

interpret CTG traces, failure to incorporate the clinical picture, delay

in taking action and poor communication. We hope that the content

of this book will at least partly contribute to resolving these issues.

In promoting safe motherhood as espoused by the World Health

Organization, our objectives must be to optimize:

• the health of the mother

• the health of the offspring

• the emotional satisfaction of the mother and her family.

In developing countries with high maternal and perinatal mortality

rates and limited resources, circumstances dictate that efforts are

directed primarily at the fi rst two objectives. In more-developed

countries with less-frequent mortality and morbidity, attention can

also be focused on the third goal.