Consumer Information on Fetal Heart Rate Monitoring During Labor

Abstract

Electronic fetal monitoring (EFM) is used for the majority of births that occur in the United States. While there are indications for use of EFM for women with high-risk pregnancies, its use in low-risk pregnancies is less evidence-based. In low-risk women, the use of EFM is associated with an increased risk for cesarean birth compared with the use of intermittent auscultation of the fetal heart rate. The purpose of this investigation was to evaluate the existence of evidence-based information on fetal heart rate monitoring in popular consumer-focused maternity books and Web sites. Content analysis of information in consumer-oriented Web sites and books was completed using the NVivo software (QRSinternational, Melbourne, Australia). Themes identified included lack of clear terminology when discussing fetal monitoring, use of broad categories such as low risk and high risk, limited presentation of information about intermittent auscultation, and presentation of EFM as the standard of care, particularly upon admission into the labor unit. More than one-third of the sources did not mention auscultation, and conflicting information about monitoring methods was presented. The availability of accurate, publically accessible information offers consumers the opportunity to translate knowledge into the power to seek evidence-based care practices during their maternity care experience.

Intermittent Auscultation for Intrapartum Fetal Heart Rate Surveillance: American College of Nurse‐Midwives

“…32 Involving low-risk laboring women in shared decision making and offering informed choice about mode of fetal monitoring may further add to their satisfaction with the experience of labor and birth. 33,34 Since IA requires a ratio of one care provider to one woman and near constant presence in order to perform auscultation at the recommended frequency, this method of fetal surveillance during labor may also contribute to improved outcomes and increased patient satisfaction. 35…”

“…In a systematic review of factors contributing to women's satisfaction with the experience of childbirth (N = 45,000), investigators identified the 4 most important factors: personal expectations, amount of caregiver support, quality of caregiver support, and involvement in decision making . Involving low‐risk laboring women in shared decision making and offering informed choice about mode of fetal monitoring may further add to their satisfaction with the experience of labor and birth . Since IA requires a ratio of one care provider to one woman and near constant presence in order to perform auscultation at the recommended frequency, this method of fetal surveillance during labor may also contribute to improved outcomes and increased patient satisfaction …”

A pilot exploratory investigation on pregnant women’s views regarding STan fetal monitoring technology

“…Analyses carry implications for maternity care providers’ communication of STan to consumers; specifically, how STan is intended to alert clinicians to problems in labour before they escalate, rather than respond to problems after they become emergencies [ 6 ]. This may be important given results of a previous study that reported variable accuracy in the content of consumer-focused maternity information about fetal monitoring [ 33 ].…”