SHE breathes a little faster. She urinates less. Then her heart rate and blood pressure race up.
There are telltale little early warning signs that a mother in childbirth is running in to trouble, in to potentially deadly obstructive labour.
Edinburgh obstetrician and gynaecologist Isioma Okolo knows how to spot them. That means she - and anyone else with her knowledge - can save lives, women and babies. And not just in her home hospital, St John’s in Livingston, but abroad too.
Dr Okolo was part of a scheme to pass on what she knows in Uganda, where far far too many women die trying to bring life in to the world.
“It is nothing fancy”, she says, describing the how she trained midwives and other health workers to track the process of labour. She is not talking about expensive or complex equipment, but life-saving pen-pushing: partographs and early warning score charts.
Dr Okolo and "Baby Anne", a mannequin used for training, by Rod Penn
It may not be fancy or high-tech but Dr Okolo’s work - and that of colleagues - has caught the eye of the UK International Development Secretary Rory Stewart.
The one-time Tory leadership candidate is rethinking British foreign aid, trying to figure out how to deliver better on the UN’s Sustainable Development Goals, at home and abroad. Last month the UK formally launched a Voluntary National Review of its aid programmes.
READ MORE: Baroness Suggs on UK's aid goals
It does not get more basic that making sure women do not die in childbirth. In Scotland, there are roughly five maternal deaths for every 100,000 births.
In Uganda the figure is disputed. But Unicef has estimated that a woman in sub-Saharan Africa has a a one in 16 chance of losing her life because of complications related to pregnancy.
The antenatal clinic at Kyanzanga referral centre
Dr Okolo, a specialist registrar in the last year of her training to be a consultant, says one of the main reasons is delay in fixing an obstructive labour: delay realising there is a problem; delay getting to hospital; delay getting the right diagnoses.
“What often happens is women arrive in the unit quite late - perhaps they have taken a while to decide to come to the hospital or the transportation has taken a while to get access. Then there are loads of other women ahead of them.
“By the time the woman actually arrives and obstructive labour is diagnosed, the baby is dead.”
READ MORE: Scots aid worker opens up about life in Yemen's war zone
Dr Okolo last year spent five weeks in Kitovu Hospital in the Ugandan city of Masaka . She was the latest in a series of doctors from the UK to make the trip under a scheme run by the Royal College of Obstetricians and Gynaecologists thanks to a funded fellowship and support from Mr Stewart’s DFID.
Corridor leading to maternity ward of Masaka Regional Referral Hospital, by Rod Penn
She explains: “The scheme is called resilience in obstetric skills. The aim of the project is to create a critical mass of Ugandan health care workers who would be able to go on teaching emergency obstetrics skills.
“We were teaching the way of identifying when things go wrong, when there is obstructed labour that would prompt a midwife to seek the help of a doctor or to start the woman
“It is a way of preventing things like fistula, which is the result prolonged obstructive labour and can kill.”
Dr Okolo was providing top-up training and monitoring the impact of previous work by other British doctors.
She says: “One of the doctors in one of the hospitals said he believed that since the start of the project they had seen a drop in their maternal mortality rate. I think it might be too soon to say and there would be lots of factors involved.”
But her work was not just to teach. It was to learn, and not just through gaining experience.
Ugandans, she say, have developed smart ways to handle shortages of staff and resources, something she admits she encounters in the NHS too.
An example: task sharing, when midwives are trained in specific jobs normally done by doctors, such as Ventouse deliveries, when babies are “sucked” out when mothers are exhausted.
The sign at Kitovu Hospital Clinical Centre, by Rod Penn
There are difficult messages for Ugandan staff too. Overworked and under-resourced they are sometimes accused of poor bedside manner, and lacking respect for the privacy of patients.
Dr Okolo says: “One of the big barriers to accessing medical care is negatives stories they have heard from a sister or a mother, that care was provided in a not very dignified or private way.”
READ MORE: Inside Africa’s largest refugee crisis in Uganda
The scheme does seem to have boosted professionalism,. Dr Okolo says. But that is because there is good “buy-in” from locals. “It’s not top-down,” she says.
Mr Stewart thanks Dr Okolo and urged others to follow her lead. He said: “There is much to be proud of in our extraordinary country, but we also still have lots to learn - including from the developing world - on tackling big issues like climate change and diseases that cross borders, such as Ebola and malaria.
“It’s fantastic to see the impact Isioma has made by volunteering in Uganda to train doctors and nurses, returning with invaluable skills and experience that can also be used in the UK."
Rory Stewart
Dr Okolo, 32, was born and brought up in a very different part of Africa, Nigeria, before coming to Edinburgh to study medicine as a teenager
As a young black woman of African origin, she reckons she got clear and honest feedback from her Ugandan hosts. Now she believes there could be a bigger role in diaspora NHS staff in planning, delivering and evaluating aid, and picking up on cultural nuances.
"If I had gone out to Uganda with a Ugandan who was working in the NHS my experience would probably have been much easier," she says. "I wonder if encouraging people from the diaspora as a way of improving the efficiency of aid - and addressing the issue of brain drain."
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