Midwives’ perspectives on the use of intermittent fetal auscultation and continuous cardiotocography during labour

Abstract

During labour the fetal heart rate (FHR) and maternal contractions may be assessed by two different monitoring methods: intermittent fetal auscultation (IA) and continuous cardiotocography (CTG). The aim of the study was to explore midwives’ perspectives on the use of IA and continuous CTG during labour. The objectives of this study were to determine midwives’ choice of intrapartum fetal heart rate (FHR) monitoring methods in different circumstances, and factors which influence midwives’ choice, and to assess midwives’ views on the advantages and disadvantages of each monitoring method, as well as to explore midwives’ views on how FHR monitoring methods affect wider intrapartum care. A qualitative research approach was chosen, and one-time, face-to-face, semi-structured interviews were conducted with a purposive sample of eight midwives. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis, as described by Nowell et al. (2017). The findings of the study indicated that the method of fetal monitoring used by midwives depends on various factors, including risk assessment and labour stages. Participants indicated that they are more likely to use CTG monitoring during the second stage of labour. It seemed that midwives also considered maternal choice to be an essential part in the decision of the fetal monitoring method used during labour. Furthermore, external factors influenced the midwives’ choice of fetal monitoring, as the participants worked in a medicalised system of care. Hospital protocols also impacted the choice of fetal monitoring methods, especially the admission CTG as it is expected to be performed on all labouring mothers regardless of risk status. Midwives suggested various advantages and disadvantages of both IA and continuous CTG monitoring. In fact, midwives viewed both fetal monitoring methods as being easy to use, but claimed that CTG reassures them more than IA. According to participants, each method of fetal monitoring could affect intrapartum care more broadly for women and their families, with CTG restricting maternal mobility, increasing maternal anxiety, and impeding the midwife-mother relationship. Whilst IA promotes both maternal mobility and the midwife-mother relationship. Midwives also claimed that obstetric-led care and lack of discussion with obstetricians may be a barrier to the use of IA and the implication for this type of practice. From the findings of the study, several recommendations for practice, education and further research are suggested. Local intrapartum guidelines with respect to fetal monitoring methods should be compiled and made easily accessible. For education, the introduction of continuous professional development courses catered for both midwives and obstetricians should be offered, so that safe use of IA and CTG is achieved. Moreover, the need to conduct large scale quantitative research which focuses on midwives’ experiences will help gain a deeper understanding and might provide more awareness on fetal monitoring methods amongst midwives.