Intermittent auscultation is a logical, evidence-based option for many women. But many women struggle to access it. A recent study from the UK set out to investigate both the barriers to using intermittent auscultation during labour and the factors that support its use (MacLellan et al., 2026). The research is part of a larger project called Listen2Baby. Let’s see what they found…
How the research was done
The research was conducted in 11 maternity units in England and Wales, selected to try to achieve maximum variation. Interviews, informal conversations, and observations of practice were used to gather information – with midwives, student midwives, obstetricians, and a maternity support worker taking part. Notably, the study looked at the facilitators and challenges of using intermittent auscultation according to national guidance – which recommends it only for the small proportion of women who are considered low risk. This means they will not have considered how to expand the use of intermittent auscultation for women with risk factors. They used a framework called the Consolidated Framework for Implementation Research that (like all research frameworks) shapes the way the issues are looked at and what is looked for.
What they found
While midwives saw the performance of intermittent auscultation as a “bread and butter” staple of midwifery practice, it was positioned as requiring less skill but also (ironically) requiring more time than CTG use, which was considered as the more legitimate monitoring approach. These beliefs were reinforced through documentation requirements that asked midwives to repeatedly verify that intermittent auscultation remained the appropriate choice but did not require the same when CTG monitoring was in use. Educational meetings also focussed on CTG interpretation skills and not on intermittent auscultation.
Intermittent auscultation in the UK had become associated with the politically contested concept of “normal birth ideology”, making midwives reluctant to advocate for it. This further marginalised intermittent auscultation. With falling rates of use, midwives and students felt less confident in using intermittent auscultation. Confidence, or the lack of it, in intermittent auscultation was a strong predictor of its use.
The physical environment and resources available were also not conducive to intermittent auscultation. A clock with a second hand facilitates counting when the available Dopplers don’t have a display screen, but these were not always available or positioned where they were easily visible. Functioning Dopplers were not always available. Digital documentation in some places required midwives to leave the birth room to access a work station, which is unworkable when performing frequent periods of auscultation.
Where there was strong organisational support for midwifery led care in alongside midwifery units and regular multidisciplinary review of birth interventions, intermittent auscultation was better supported. Dedicated training in intermittent auscultation occurred at three sites and midwives here reported feeling more confident about using intermittent auscultation and communicating with obstetricians if transferring care.
One finding that really stood out for me was that one of the facilitating factors for intermittent auscultation use was an embedded practice that serious concerns raised by intermittent auscultation could trigger direct transfer to the operating theatre, rather than transfer first to the obstetric unit for CTG monitoring. This is something I teach and advocate for, and it was lovely to see the power of this simple policy change as a way to recognise the legitimacy of data obtained from intermittent auscultation.
What this means
The findings from this study align with those from studies in the USA (Chuey et al, 2020; DeVries et al, 2025), while demonstrating that local specific influences have their own impacts on the use of intermittent auscultation. What stood out for me were the social factors that are often dressed up as the material reality of intermittent auscultation were brought to light.
If you build digital and physical infrastructure that makes documentation of intermittent auscultation hard work, couple it with a requirement that decisions about intervention are only made on the basis of CTG recordings, then you create the situation where it is inevitable that data from intermittent auscultation is seen to not be either trustworthy or worth the effort required to produce it. Solve these problems, and intermittent auscultation becomes a trustworthy option.
Identifying these sorts of influences at local level is a key to making it easier for women to access intermittent auscultation where you work. Research like this provides useful clues about where to look and what to look for. This doesn’t require a team of fancy researchers – just an informed and curious mind. You can do this too. You may find that small and simple changes (putting the clock in the room in a position that makes more sense) may help nudge the dial in the right direction.
If you are working somewhere that doesn’t provide you with education on how to use intermittent auscultation, it is easy to lose (or never develop) a sense of confidence about it. I can’t teleport into your workplace, rearrange the clocks, order a bunch of Dopplers that actually work, or rewrite your policy to make it easier for you to use intermittent auscultation. But what I can help with is knowledge about how intermittent auscultation stacks up as a choice, and a physiology informed approach to how to actually do it and make sense of what you are hearing and seeing on the screen of the Doppler.
If that sounds like a good starting point, then I want you to know that I’m gearing up to run my live workshop Confident Intermittent Auscultation once again. I’m still lining up my ducks and figuring out possible dates. Add your name to the waiting list and you’ll be sure to hear about it (and I have plans to have a special subscribers only early bird discount option for the first day of enrolments).
Confidence is just around the corner…
References
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 Perinat al & Neonatal Nursing, 34(1), 46-55. https://doi.org/10.1097/JPN.0000000000000453
De Vries, R. G., Low, L. K., Chuey, M., Abdelnabi, S., & Lewallen, M. (2025). When Evidence Fails to Change Practice: Examining the Persistence of Continuous Fetal Monitoring. Qualitative Health Research, 10497323251347137. https://doi.org/10.1177/10497323251347137
MacLellan, J., Ade, M., Douthwaite, M., Fitzsimons, B., Joash, K., Mulla, S., Sanders, J., Kenyon, S., Pope, C. J., & Rowe, R. (2026). Facilitators and barriers to the practice of intermittent auscultation fetal monitoring in UK maternity services: a qualitative study using the Consolidated Framework for Implementation Research (CFIR). BMJ Open, 16(4), e115855. https://doi.org/10.1136/bmjopen-2025-115855
Categories: CTG, IA, New research
Birth Small Talk 