I wrote this post back in February 2020 when this research was new. It’s a paper I often reference and use in my presentations. I’ve refreshed the post and am sharing it again because I think it contains valuable information.
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 CTG monitoring during labour. 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: professionals 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 centred around the need to have women sign a waiver when they chose intermittent auscultation, rather than a 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.
It is clear this is a complex issue. If we are to see an uptake in intermittent auscultation, it will require midwives and obstetricians (and obstetric nurses in the USA) making significant effort to modify workplace culture and power structures. Any interventions to change approaches to fetal monitoring must centre women’s decisions.
Four years on – nothing much has changed. Changing belief systems is hard. The driving force behind BirthSmallTalk is my desire to develop maternity professionals knowledge of the evidence and confidence in discussing it and acting on it. There is work to be done!
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Reference
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
Categories: CTG, EFM, IA, New research
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