Research published this week by Chuey, De Vries, Dal Cin, and Low (2020) explored facilitators and barriers to the use of intermittent auscultation (IA) rather than intrapartum CTG monitoring. The authors pointed out that:
Despite evidence-based guidelines from professional associations recommending IA, and warning against the use of continuous monitoring, healthy individuals in labour are rarely monitored intermittently. The harms of routine EFM use are well established, yet it continues to be used ubiquitously.Chuey, et al., 2020, p. 52
The research was conducted in the USA, where the research team spoke with 41 doctors, nurses, and midwives working in maternity care. They found seven factors played a role:
- Clinical environment: this included staffing levels, organisational culture, and convenience.
- Technology: care providers were comfortable with CTG technology and felt unsure of how to provide care without it.
- Policies, procedures, and evidence-based protocols: there were often differences between what was done in practice and what was written in procedures.
- “Patient”-centred influences: conversations around consent with respect to fetal monitoring centred around the need to have women sign a waiver when they refused CTG monitoring, rather than the requirement for informed consent for CTG use.
- Fear of liability: providers believed that CTG use would prevent the risk of litigation and provide useful defence if this occurred.
- Providers as members of the healthcare team: there was a belief that different professional groups had different perceptions of risk which influenced recommendations to use CTG monitoring.
- Deflection of responsibility: doctors and midwives felt that nurses drove the use of CTG monitoring, while nurses felt that obstetricians drove the use of CTG monitoring.
They concluded with a series of recommendations, which makes it clear that this is a complex issue, requiring inter-professional efforts to modify workplace cultures and power differentials. They highlighted that any interventions to change the approach to fetal monitoring must centre the birthing individual’s choices within the decision making framework.
Chuey, M., De Vries, R., Dal Cin, S., & Low, L. K. (2020). Maternity Providers’ Perspectives on Barriers to Utilization of Intermittent Fetal Monitoring: A Qualitative Study. Journal of Perinatal and Neonatal Nursing, 34(1), 46-55. doi:10.1097/JPN.0000000000000453