Maternity care systems are complex structures, made up of people in various roles, physical infrastructure, policy environments, and embedded cultural practices and beliefs. When you add a new piece of technology to this mix, it is almost a given that something unanticipated will happen in response to the new technology. These happenings are known as unintended consequences (UCs). There is a growing body of research that has cataloged and explored UCs in healthcare.
I set out to examine social issues among maternity clinicians in relation to a central fetal monitoring system. The approach I used in my doctoral research – known as Institutional Ethnography – uses an entry point in to the research process known as a disjuncture. This is something that people experience that doesn’t make sense to them. As I started talking to people and observing them at work, one particular event was raised repeatedly with me. The midwives referred to it as “being K2ed”, in reference to the name of the central fetal monitoring system.
Along with my supervisors, Mary Sidebotham, Jenny Gamble, and Jennifer Fenwick, I have recently published a paper describing “being K2ed” as an UC following on from the introduction of the central fetal monitoring system (Small et al, 2021a). You can read it here.
In the paper we described “being K2ed” as occurring:
as a consequence of the birthing woman’s CTG being visible at the central monitoring station, without the key contextual information available to the midwife working with the woman in the birth room. CTG changes considered abnormal or uninterpretable were seen to require a response by clinicians outside the room. In the absence of textual information on the CTG indicating that the midwife was responding, one or more clinicians would enter the birth room when the midwife had not requested their presence. The clinician(s) entering the room was usually one or more doctors, but sometimes included the midwifery team leader. Entry into the room often disregarded the local convention that required clinicians to knock, then wait for the midwife to come to the door, or to give permission to enter the room.
Midwives experienced the arrival of this new person at the room as disruptive and disrespectful. As explored in another paper, we have concerns about the safety impact of “being K2ed” (Small et al, 2021b). You can read more about that paper here.
I’m keen to hear from people working with central fetal monitoring systems in other places. Does something similar to “being K2ed” happen where you work? Do you have a name for it? In what ways do things happen the same way at your hospital, or not, as our research found? Leave a comment to let me know.
Small, K., Sidebotham, M., Gamble, J., & Fenwick, J. (2021a). “My whole room went into chaos because of that thing in the corner”: Unintended consequences of a central fetal monitoring system. Midwifery, in press. https://doi.org/10.1016/j.midw.2021.103074
Small, K., Sidebotham, M., Fenwick, J., & Gamble, J. (2021b). “I’m not doing what I should be doing as a midwife”: An ethnographic exploration of central fetal monitoring and perceptions of clinical safety. Women and Birth, in press. https://doi.org/10.1016/j.wombi.2021.05.006