Much of the focus in research about fetal monitoring in labour has been on outcomes for the fetus / baby. Not as much has looked at women’s outcomes, and even less has looked at what women say about their experiences with CTG monitoring. But there has been some research, and a team of researchers recently pulled it all together in the one place (Murray et al., 2024).

Murray and colleagues searched for studies that have reported on women’s experiences with CTG monitoring in labour in high-income countries. They included studies where women used a fetal spiral electrode, external Doppler sensors, wired, wireless (or telemetry), and beltless approaches to CTG monitoring. They found 18 studies in total, conducted in the 47 year period between 1976 and 2023. The studies were conducted in the United Kingdom, the United States of America, Australia, Ireland, Denmark, and Canada.

What did they find?

The authors described three main themes:

• Feeling reassured vs feeling anxious about the welfare of the baby
• Feeling comfortable and free to be mobile vs uncomfortable and restricted
• Feeling reassured and empowered vs feeling depersonalised with minimal control

Reassurance and anxiety

Some women reported feelings of comfort, safety, and security when CTG monitoring was in use, and the heart rate pattern was normal. Others reported feeling fearful, nervous, or concerned because the heart rate pattern was not normal, or when there were periods where the heart rate was not being detected by the sensors.

Freedom vs restriction

Women’s experiences with the level of discomfort experienced and the degree to which their mobility was impacted depended (not surprisingly) on the specific technology in use. External sensors connected to the machine by wires and held in place by straps were the source of discomfort and restriction for many who used this monitoring approach. Fetal spiral electrodes were uncomfortable to have attached, but did allow for greater levels of freedom and comfort once they were in place. While women using wireless and beltless technology reported better freedom of movement, there were still reports about the fiddling and poking required to ensure a consistent recording was obtained.

Empowered vs depersonalised

Again, the type of technology women experienced modified their experiences here. Women reported reduced levels of care with CTG use (rather than with intermittent auscultation), and also less privacy as people came to the room to look at the CTG. Women using wireless and beltless technology were more likely to report favourable experiences. I wonder if this relates to the context of the study, where the introduction of new technology being assessed in a research study leads to more attention to information provision and supported decision making, than is the experience of most women using fetal monitoring in labour.

Why this research matters

We lack really strong evidence to show whether CTG monitoring does, or does not, make outcomes better for the fetus / baby. Without this evidence, knowing what it is like to have one or other approach to fetal monitoring in labour is particularly useful for women to consider when deciding which fetal monitoring approach to use. Be aware that not all the technologies described in this research are available in all birth services. Even if a technology is available, it may not be available on the day (for example all the telemetry machines might be in use already). Having a plan B option when your preferred choice isn’t available is a good idea!

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References

Murray, S., Fox, D. J., Coddington, R. L., & Scarf, V. L. (2024, May 15). How does the use of continuous electronic fetal monitoring influence women’s experiences of labour? A systematic integrative review of the literature from high income countries. Women & Birth, 37(4), 101619. https://doi.org/10.1016/j.wombi.2024.101619 

• Reducing anxiety during antenatal CTG monitoring
• Tending to the machine: Women’s experiences of fetal monitoring in labour

Categories: CTG, EFM, New research

Tags: anxiety, Decision-making, Depersonalisation, Empowerment, Experience, Freedom, Literature review, Reassurance, Restriction