Objective To investigate midwivesÕ attitudes, values and beliefs on the use of intrapartum fetal monitoring.Design Qualitative, semi-structured interviews Subjects and setting Fifty-eight registered midwives in two hospitals in the North of England.Results In this paper two main themes are discussed, these are: informed choice, and the power of the midwife. Midwives favoured the application of informed choice and shared a unanimous consensus on the definition. However, the idealistic perception of informed choice, which included contemporary notions of empowerment and autonomy for women expressing an informed choice, was not reportedly translated into practice. Midwives had to implement informed choice on intrapartum fetal monitoring within a competing set of health service agendas, i.e. medically driven protocols and a political climate of actively managed childbearing. This resulted in the manipulation of information during the midwivesÕ interactions with women. This ultimately meant that the women often got the choice the midwives wanted them to have. ConclusionsThe information that a midwife imparts may consciously or subconsciously affect the woman's uptake and understanding of information. Therefore, the midwife has a powerful role to play in balancing the benefits and risk ratios applicable to fetal heart rate monitoring. However, a deeply ingrained pre-occupation with technological methods of intrapartum fetal monitoring over many years has made it difficult for midwives to offer alternative forms of monitoring. This has placed limits on the facilitation of informed choice and autonomous decision making for women.

Over the last 20 years in the United Kingdom, midwives have implemented the routine use of intrapartum fetal monitoring regardless of the risk status of laboring women. This practice is at odds with the published research. The discrepancy between practice and best evidence merits further investigation. A qualitative study was conducted to evaluate midwives' attitudes and experiences about the use of fetal monitoring for women at low obstetric risk. Fifty-eight midwives working in two hospitals in the north of England were interviewed by using a semistructured approach. The taped interviews were transcribed and analyzed by using a general thematic approach. Issues included midwives' perceptions of low-risk status, the socialization of midwives, and the loss of woman-centered care. Midwives subscribed to the notion of woman-centered care, but because of a complexity of factors experienced in their daily working lives, they felt vulnerable when attempting to implement evidence-based fetal monitoring practices. Midwives regretted the loss of a woman-centered approach to care when technologic methods of intrapartum fetal heart rate monitoring were used indiscriminately. An appreciation of the complex factors affecting the ability of midwives to implement evidence-based practice is important when attempting to facilitate the development of appropriate fetal monitoring practices for women at low obstetric risk.

In the UK, fear of birth (FoB) is considered a valid reason to request an elective caesarean section, and the National Institute for Health and Care Excellence ( NICE, 2011 ) provided guidance in respect of women with a FoB requesting operative delivery. However, it was not clear how many maternity units in the UK offered support for women in line with this guidance. Consequently, a national online audit survey was undertaken to determine current service provision in maternity units. Hence in 2013, 202 maternity units were surveyed over 9 weeks; there was a 63% (n=128) response rate. It was evident that 47.3% (n=52) of all units did not offer specialist support for women with FoB. However, where support was available, this varied from the benchmark recommendation for referral to a consultant obstetrician (NICE, 2001) to specialist midwifery clinics and psychological support services. Overall, the survey revealed that care pathways for FoB had not been widely implemented in the UK.

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Purpose -The routine use of intrapartum electronic fetal monitoring (EFM) has resulted in an increased burden of operative and vaginal instrumental deliveries for women at low obstetric risk. Such modes of delivery increase maternal mortality and morbidity risks. This study aims to explore midwives' values, attitudes and beliefs when using intrapartum fetal monitoring techniques in clinical practice. Design/methodology/approach -A total of 58 registered midwives across two NHS Trusts in one region in the north of England were interviewed using a qualitative approach. Findings -Midwives attempted to manage the psychological burden of the threat from clinical negligence by using EFM. This meant that some midwives used electronic monitoring regardless of clinical need. Midwives lack confidence in the ability of EFM to accurately detect fetal compromise but are aware that the visual monitoring record is recognised as a valuable piece of legal evidence. The midwives' perceptions of professional self-efficacy in seeking to avoid a claim in clinical negligence contributed to defensive practice.Research limitations/implications -The study was conducted in only two hospitals in one region of England; however the Trust demographics were similar and midwifery practice within the unit reflects national maternity standards of care. Practical implications -Multidisciplinary strategies may be required to overcome barriers to the effective implementation of clinical guidelines where intrapartum fetal monitoring is concerned and Trust audit departments must undertake regular audit cycles in order to ascertain practice compliance with best evidence. Originality/value -The paper provides information so that midwives' knowledge regarding the limitations of EFM can be improved.