Fetal Heart Rate Auscultation, 3rd edition

A Multimethod Improvement Project to Strengthen Intermittent Auscultation Practice Among Nurse‐Midwives and Nurses

“…For example, training materials from AWHONN assume availability of continuous EFM in the birth environment and were found to inadequately address clinician management of category II assessments. 1,11 A common way to practice auscultation skills is to compare auscultated findings with recorded EFM tracings in real patients; however, this method cannot reliably assess the practitioner's competency identifying decelerations unless the fetus is experiencing such changes, resulting in few opportunities to practice this skill and to work through management decisions based on the finding of FHR decelerations or other category II assessments. Audio simulations have been used to enhance clinical learning for other auscultation skills, including adult physical assessment with a stethoscope, resulting in improved learner experiences and diagnostic accuracy.…”

“…Specific techniques and methods were aligned with training materials provided by AWHONN. 1,11 After the training bundle was distributed, feedback and questions were solicited and compiled for a follow-up town hall conference call, which all CNMs and RNs could attend live or via a distributed recording. The town hall meetings were presented by the clinical practice committee and network-wide clinical leadership and were an open forum to discuss questions and concerns about implementing the guideline changes.…”

“…It is an auditory skill, as opposed to EFM, which is primarily visual, as the user reads and interprets a visual recording of the FHR. 1 Clinical trials comparing EFM and IA suggest that neither method is superior for detecting or averting fetal acidemia or poor clinical outcomes in the newborn. A Cochrane systematic review of 13 randomized controlled trials involving more than 37,000 participants in 7 countries found no significant differences in rates of metabolic acidosis, perinatal death, cerebral palsy, neonatal intensive care admissions, or 5-minute Apgar scores below 4 or 7.…”

“…IA is a method that uses periodic listening and counting of the fetal heart rate (FHR) to assess fetal well‐being. It is an auditory skill, as opposed to EFM, which is primarily visual, as the user reads and interprets a visual recording of the FHR 1 …”

“…Although all major professional organizations in perinatal care support the use of IA for individuals in labor who are at low risk for fetal acidemia, there is no consensus on how low risk is defined or on the risk factors for which EFM may improves outcomes 9‐11 . In addition, research evidence has not established the most effective and reliable auscultation methods, such as frequency and duration of listening and techniques for interpreting and documenting auscultation findings, 12,13 and few standardized IA‐focused training resources exist for perinatal care providers 1 . As a result, hospitals, birth centers, and home birth practices typically develop their own standards for IA technique, practice, and training approaches, resulting in the potential for significant variation in skill and practice across providers and care settings.…”