CTGs and autonomy

There are two main ways that fetal monitoring can impact women’s autonomy – their power to choose what they want for themselves. The first (and the area I focus on most in my blogs) is whether women are supported with reliable information about the different options for fetal monitoring and whether their decisions about what to use are respected. The second area is bodily autonomy. This is about freedom to move – to get off the bed to go use the toilet, or to move from standing beside the bed to sitting in the shower – without requiring permission and assistance from a maternity professional.

An Australian team of researchers have recently looked into this – by asking midwives for their thoughts on how different fetal monitoring technologies impact their ability to support women’s bodily autonomy during labour (Woodworth et al., 2026).

What did they do?

In 2024, a survey was circulated to midwives through social media channels. Midwives were eligible to complete the survey if they provided care for women in labour in Australian healthcare facilities and used some form of fetal surveillance. All up, 396 midwives completed the survey, with almost of third of them working in a midwifery continuity of carer model.

What did they find?

The vast majority said they had access to handheld Dopplers, wired and telemetry CTGs, and fetal spiral electrodes. Only 39% had access to a Pinard, and 25% had access to intrauterine pressure catheters and noninvasive fetal ECG monitors. When asked about the impact of different fetal monitoring approaches on restricted mobility for women in labour, wired CTGs came out as the worst offenders, with 95% agreeing that they restricted freedom of movement. At the other end of the spectrum, intermittent auscultation with a Doppler was the least restrictive, with the other fetal monitoring approaches (like using a fetal spiral electrode or noninvasive fetal ECG monitoring) falling between these two.

Midwives were asked about the proportion of women in their care who used intermittent auscultation throughout their entire labour and birth. Almost half reported that fewer than ten percent of women used intermittent auscultation exclusively in their care. There are clearly significant barriers in place preventing women from knowing that this is a viable option, choosing it, and receiving this as their preferred fetal monitoring option. Midwives who used intermittent auscultation more consistently (ten percent of more of the time) had consistent access to handheld Dopplers or Pinards and described having had adequate training in intermittent auscultation.

Other barriers to using intermittent auscultation were a lack of regular opportunities to use intermittent auscultation (50%), a lack of support from colleagues to use methods other than continuous CTG monitoring (only 43% said they were supported), an expectation that policy would be followed even when not in line with that the woman wanted (a whopping and highly unacceptable 95%), and fear of being reprimanded if a woman chooses intermittent auscultation (53%).

What does this mean?

This research confirms what many of us already knew – continuous CTG monitoring undermines midwives capacity to support women’s bodily autonomy. Midwives however were not consistently using intermittent auscultation. The authors concluded that wired CTG technology should be considered no longer fit for purpose.

There are some caveats to be aware of here. This study asked midwives about women’s experiences of freedom of movement. Asking women might lead to different answers – or not. The midwives who responded were more likely to work in continuity models than is typical for the entire clinical workforce, and might be more committed to concepts of woman-centred care including autonomy than is true of Australian midwives in general.

Important lessons

The evidence has been clear for a long time – compared to CTG use intermittent auscultation is a safe, effective form of fetal monitoring for labour. Yet there is still a persistent misperception that this is true only for a small handful of women, rather than the vast majority. In Australia, recent changes to the national fetal monitoring guideline should make it easier for midwives to offer and use intermittent auscultation and for women to ask for and receive intermittent auscultation. Ongoing pressure is required at all levels to see meaningful change. This means:

women knowing and demanding their rights
midwives knowing the guidelines and the evidence and supporting women’s autonomy
midwives investing in their knowledge development and buying their own intermittent auscultation equipment and using it
maternity services aligning their policy with national policy and investing in staff education and equipment

These are not impossible or even expensive things to ask for. Some of it is in YOUR power. Are you ready to get started?

The first step in claiming your autonomy around fetal monitoring is to know that your options are, and what works best. If you want nonsense free information about fetal monitoring to support YOUR birth decisions, I can help you with that.

I’m a leading expert on fetal monitoring and an experienced educator – and I have personally designed a course with up-to-date information you can rely on. Knowing what the options are, how they work (or don’t work), and what the latest research says on the benefits and risks of each gets you off to a great start when making a decision. Fetal monitoring: Informed decisions for your birth covers all this and more! You’ll also find practical and effective communication strategies that help make sure you get the type of fetal monitoring you want for your birth.

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References

Woodworth, R., Scarf, V., Coddington, R., Levett, K., Rogers, K., & Fox, D. (2026). The Mid-Tech survey: Midwives’ views about the influence of intrapartum fetal surveillance technologies upon supporting women’s bodily autonomy. Women & Birth, 39(1), 102135. https://doi.org/10.1016/j.wombi.2025.102135