From: Professionals’ views of fetal monitoring during labour: a systematic review and thematic analysis
Author/Year | Aim | Participants and study location | Key findings reported by authors | Key themes identified by reviewer |
---|---|---|---|---|
Cranston, 1980 [29] | To identify the attitudes of professionals towards fetal monitoring | 124 obstetric nurses; 14 hospitals, St Louis, USA | 88% felt that fetal surveillance by the FM could not be achieved by IA. 90% felt that the woman was more reassured by the presence of the monitor. 59% did not feel that the FM causes more patient anxiety. 98% felt that the purpose of the FM was to improve fetal outcome. EFM is one of obstetrics best inventions. | Reassurance |
Safety | ||||
Technology | ||||
Anxiety | ||||
Dover and Gauge, 1995 [14] | To find out how midwives carried out intrapartum FHR monitoring and what factors influenced choice of methods | 117 midwives of 242 (48% response rate); 3 units, England | Midwives felt confident to use IA for low-risk women; midwives would benefit from education on EFM interpretation; philosophy of childbirth affected choice of method; EFM was used when staffing levels were poor. | Reassurance |
Education | ||||
Monitor as midwife | ||||
Birch and Thompson, 1997 [28] | To determine staff attitudes to and practice of monitoring the FHR during labour | 96 professionals (14 doctors, 80 midwives, 2 unknown), (50% response rate); Consultant led unit, Wirral, England | EFM has improved outcomes; overall preference for IA; disparity between midwives’ and doctors’ responses. | Reassurance |
Safety | ||||
Sinclair, 2001 [32] | To explore how midwives used the birth technology of the CTG machine | 446 midwives of 741 (60% response rate); All labour wards, Northern Ireland | Dichotomy with respect to reliance on EFM and EFM as a source of anxiety; view that CTG is not required for safe birth; agreement that technology in childbirth is desirable. | Reassurance |
Anxiety | ||||
Technology | ||||
Walker et al, 2001 [25] | To explore nurses’ attitudes towards IA | 145 obstetric nurses; 5 units, South-East Michigan, USA | IA should be the standard of care; staff/women ratios hinder IA use; neutral response to research on EFM and clear benefits. | Education |
Monitor as midwife | ||||
Munro et al, 2002 [24] | To explore and respond to midwives’ views of different types of fetal monitoring in labour | 20 midwives; 2 maternity units, England | EFM offered reassurance; increased anxiety; EFM can hinder communication; EFM reduces mobility and increased need for pain relief; trust in technology. | Reassurance |
Anxiety | ||||
Communication | ||||
Technology | ||||
Altaf et al, 2006 [31] | To explore midwives’ views on the experience of using EFM | 20 midwives; large teaching hospital, England | Feeling of reliance on EFM; EFM can erode and undermine professional skills; EFM deflecting attention from care. | Reassurance |
Technology | ||||
Communication | ||||
Hindley et al, 2006* [20] | To explore midwives’ attitudes and experiences of intrapartum fetal monitoring | 58 midwives; 2 hospitals, northern England | Midwives were motivated to use EFM to protect themselves against potential litigation; EFM may provide reassurance; IA allowed for closeness to women and freedom of movement during labour; IA facilitated a more natural approach to childbirth; danger of losing skills with over-reliance on technology; EFM used when busy. | Reassurance |
Litigation | ||||
Communication | ||||
Technology | ||||
Monitor as midwife | ||||
Blix and Ohlund, 2007 [26] | To explore what information the labour admission test is perceived to provide in the daily work of midwives | 12 midwives; four maternity units, Norway | The core category ‘experiencing contradictions’ was explained by three sub-categories; professional identity versus technology, feeling safe versus feeling unsafe and power versus powerlessness. | Safety |
Technology | ||||
McKevitt et al, 2011 [30] | To examine midwives’ and doctors’ attitudes towards the use of the CTG machine in labour ward practice | 29 of 56 midwives (52%) and 11 of 19 doctors (58%) (survey); 6 midwives and 2 doctors (interviews); maternity unit, Northern Ireland | Questionnaires: CTGs lead to unnecessary interventions; disagreement that technology in childbirth is undesirable; agreement re use of CTG not distracting attention from mother; CTGs used unnecessarily; disagreement in always trusting the CTG and in feeling vulnerable without it; decision-making for intervention; Interviews: determining appropriate usage-CTG monitoring used to provide reassurance; reaching a decision, communication and collaboration on CTG interpretation; professional concerns-limited evidence to support CTG use, increased intervention; the way forward-more research to improve technology to monitor the fetus. | Technology |
Communication | ||||
Reassurance | ||||
Education | ||||
Hill, 2011 [27] | To explore midwives’ views and experiences of using intermittent auscultation of the fetal heart during labour | 8 midwives; large urban maternity unit, Ireland | Lack of policies and guidelines on use of IA; need to provide proof of the FHR; vulnerable to litigation; culture of the organisation; medicalisation, industrialised birth and technology; walking a tightrope = dilemma of wanting to use IA, busy clinical environment and feeling vulnerable | Communication |
Reassurance | ||||
Litigation | ||||
Technology | ||||
Monitor as Midwife |