A survey of regional guidelines for intrapartum electronic fetal monitoring in women at low obstetric risk

Hinsliff²,

J Midwife Womens Health

2006

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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.

Section: Methodsmentioning

confidence: 99%

“…The full 3‐year study entailed two parts. Part one involved a quality appraisal of all regional guidelines on EFM 10 using a specifically developed tool 11 . Part two involved surveys of childbearing women and interviews with midwives.…”

Section: Introductionmentioning

confidence: 99%

English Midwives' Views and Experiences of Intrapartum Fetal Heart Rate Monitoring in Women at Low Obstetric Risk: Conflicts and Compromises

Hinsliff²,

J Midwife Womens Health

2006

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“…Although some of the guidelines in this study were better evaluated, the mean overall score for the sample indicated that many were of poor quality (Hinsliff et al. 2004).…”

Section: Discussionmentioning

confidence: 87%

Developing a tool to appraise fetal monitoring guidelines for women at low obstetric risk

Hinsliff

Journal of Advanced Nursing

2005

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“…Fifty‐eight midwives were interviewed from two hospitals in the north of England. The hospitals were chosen according to criteria published elsewhere by the researchers 5 . These were anonymized as centre A and centre B; both served an urban population with a variable socio‐economic and ethnic mix.…”

Section: Methodsmentioning

confidence: 99%

The rhetoric of informed choice: perspectives from midwives on intrapartum fetal heart rate monitoring

2005

Health Expectations

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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.