Last week I posted about a literature review that summarised 47 years of research about women’s experiences of labour. The same research team responsible for that paper, has also just recently published new Australian research (Fox et al., 2024) describing women’s current experiences with fetal monitoring in labour. The paper has been published in an open access journal, so you are able to read the full paper yourself. If you want to do so – you’ll find the link to the paper in the reference list below.
How was the research done?
The research team developed an online survey and circulated it using social media channels in 2022. Women who had given birth in Australia in the previous five years and had used any form of fetal monitoring in labour were eligible to take part. In addition to questions where women were asked to select one option from a list, several free text questions were asked and a detailed written response was able to be provided. This research has analysed these written responses. The research is part of a bigger project about fetal monitoring in labour, so more papers are yet to come!
What did they find?
The researchers asked about the type of fetal monitoring women had experienced. Handheld devices (I presume Dopplers although Pinard stethoscopes might be included here) were reported by 16%, wired forms of CTG monitoring by 35%, wireless CTG monitoring by 20%, and the use of a fetal spiral electrode by 5%. Some combination of multiple options was reported by 22% of women. The written responses therefore reflect this range of commonly used fetal monitoring technologies.
No mention was made about the use of central fetal monitoring or computer interpretation of the CTG – presumably the use of these was not posed as a question in the survey. It would be useful to make sure we are capturing information about these specific technologies, as they too have the potential to impact on women’s experiences. When they are in use, they often remains invisible to women, until something unexpected happens (such as people entering the birth room because they have seen something at the central monitoring station).
The results were presented in two main categories. “Tending to the machine” focussed on women’s experiences of how maternity professionals interacted with the fetal monitoring technology and with the woman in relation to the use of this technology. The second category, “Impressions of the machine” focussed on women’s direct experiences with the fetal monitoring technology.
Tending to the machine
Survey participants described how CTG technology became a central focus in the birth room – called “midwifing the monitor” in their analysis. Working with the technology took up time and focus from their midwife. Women described feeling somewhat invisible – as professionals looked to the machine for definitive information and sometimes discounted women’s reports about what was happening in labour (like how often they were contracting). A lack of privacy was also reported, relating to people often coming and going from the birth room to look at the CTG.
Fetal monitoring technology was described as “bringing the baby into the room”, and this was experienced as a “double edged sword”. Women reported being reassured and comforted by the sound and visual evidence of a normal fetal heart rate. When the heart rate was not normal, or machine generated alarms sounded, anxiety was generated instead. One woman described anticipatory anxiety each time she was about to have intermittent auscultation.
Impressions of the machine
Women reported feeling discomfort and restriction from CTG technology. This was true with both wireless and wired technology, including fetal spiral electrodes. The need to frequently adjust equipment was described as taking women “out of the zone” where they focussed on internal cues to labour.
A large part of the write up focussed on issues around information giving and consent. CTG technology was often presented as mandatory, with the use of CTGs then often precluding women from accessing water immersion during labour. Women reported a mismatch between what they had been told during the antenatal period about fetal monitoring and what happened during labour and how difficult it was to have their decisions about fetal monitoring carried out. Some women described being re-traumatised by the use of CTG monitoring as elements of their experience overlapped with previous experiences of sexual assault.
In summary…
The findings from this recent research reflect those from prior research, and provide updated evidence. Women considering their options for fetal monitoring might find it helpful to read the paper with an eye out for the comments about “what I wished I knew…”, and use these as the starting point for a conversation with their maternity professional.
Maternity care systems and the professionals who work in them really do need to do better when it comes to information sharing and supporting, acknowledging, and respecting women’s decisions about fetal monitoring in labour. I’m going to leave the final words to the authors of the paper.
Prioritising the individual needs of the woman or birthing person is key to providing high quality woman-centred intrapartum care. Women should be provided with adequate information regarding the risks and benefits of different forms of fetal monitoring including how the form of monitoring might impact her labour experience.
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References
Fox, D., Coddington, R., Levett, K. M., Scarf, V., Sutcliffe, K. L., & Newnham, E. (2024). Tending to the machine: The impact of intrapartum fetal surveillance on women in Australia. PLoS ONE, 19(5), e0303072. https://doi.org/10.1371/journal.pone.0303072
Categories: CTG, EFM, New research
Tags: Australia, Decision-making, Experience
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