Maternal and fetal mortality remains a main public health challenge, predominantly in low- and middle-income countries (LMICs), according to the WHO reports, where most preventable deaths occur during labor and delivery. In these settings, intrapartum monitoring for low-risk pregnancies mainly relies on intermittent auscultation (IA), a low-cost and non-invasive technique. However, conventional IA is limited by subjectivity, lack of standardized documentation, inability to measure uterine contractions, and inconsistent application in overcrowded and understaffed labor wards. Although continuous electronic fetal monitoring is widely used in high-income settings, its cost, infrastructure requirements, and increase in cerebral palsy and also routine use of admission cardiotocography for low-risk women on entrance to the labor ward have led to an increase in cesarean delivery (C-section and instrumental delivery) rates, and training demands limit its applicability in resource-constrained environments. This study aims to design a context-appropriate labor monitoring device based on intermittent auscultation for use in low-resource settings. Using the Bio Design innovation process, unmet clinical needs were identified through literature review and stakeholder-informed contextual analysis. The proposed solution is a portable, multi-sensor system capable of intermittently measuring fetal heart rate, maternal heart rate, and uterine contractions while enabling basic data recording, local storage, and periodic alert functionality to support timely and standardized monitoring. The anticipated outcome of this thesis is a functional proof-of-concept prototype that improves the reliability and consistency of intermittent labor monitoring without increasing complexity or cost. Through key limitations of traditional and handheld Doppler IA, the proposed device has the potential to enhance early detection of labor-related complications, support overburdened healthcare providers, and contribute to improved intrapartum care and maternal-fetal outcomes in LMICs. Keywords: Intermittent auscultation; Labor monitoring; Low-resource settings; Fetal heart rate; Maternal heart rate; Uterine contraction; Bio Design innovation process.
