Abstract
Background
Central fetal monitoring systems transmit cardiotocograph data to a central site in
a maternity service. Despite a paucity of evidence of safety, the installation of
central fetal monitoring systems is common.
Aim
This qualitative research sought to explore whether, and how, clinicians modified
their clinical safety related behaviours following the introduction of a central monitoring
system.
Methods
An Institutional Ethnographic enquiry was conducted at an Australian hospital where
a central fetal monitoring system had been installed in 2016. Informants (n = 50) were midwifery and obstetric staff. Data collection consisted of interviews and
observations that were analysed to understand whether and how clinicians modified
their clinical safety related behaviours.
Findings
The introduction of the central monitoring system was associated with clinical decision
making without complete clinical information. Midwives’ work was disrupted. Higher
levels of anxiety were described for midwives and birthing women. Midwives reported
higher rates of intervention in response to the visibility of the cardiotocograph
at the central monitoring station. Midwives described a shift in focus away from the
birthing woman towards documenting in the central monitoring system.
Discussion
The introduction of central fetal monitoring prompted new behaviours among midwifery
and obstetric staff that may potentially undermine clinical safety.
Conclusion
This research raises concerns that central fetal monitoring systems may not promote
safe intrapartum care. We argue that research examining the safety of central fetal
monitoring systems is required.
Keywords
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References
- Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.Cochrane Database Syst. Rev. 2017; 2: 1-137
- Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: literature review.Women Birth. 2020; 33: 411-418
- An overview of central fetal monitoring systems in labour.J. Perinat. Med. 2013; 41: 93-99
- K2MS Guardian. A Supportive Clinical Care Structure for Labour. Volume 2: Improving Birth Outcomes.2017
- Does centralized monitoring affect perinatal outcome?.J. Matern. Fetal Neonat. Med. 1997; 6: 317-319
- Central fetal monitoring: effect on perinatal outcomes and cesarean section rate.Birth. 2006; 33: 284-288
- Birth outcomes, intervention frequency, and the disappearing midwife-potential hazards of central fetal monitoring: a single center review.Birth. 2016; 43: 100-107
- An exploration of the views and experiences of midwives using intermittent auscultation of the fetal heart in labor.Int. J. Childbirth. 2016; 6: 68-77
- An epistemology of patient safety research: a framework for study design and interpretation. Part 1. Conceptualising and developing interventions.Qual. Saf. Health Care. 2008; 17: 158-162
- Medical teamwork and the evolution of safety science: a critical review.Cogn. Technol. Work. 2019; : 1-15
- How to be a very safe maternity unit: an ethnographic study.Soc. Sci. Med. 2019; 223: 64-72
- Social Organisation of the Work of Maternity Clinicians Related to a Central Fetal Monitoring System.Griffith University, 2020
- Institutional Ethnography. A Sociology for People.AltaMira Press, Lanham2005
- Conducting analysis in institutional ethnography: analytical work prior to commencing data colletion.Int. J. Qual. Methods. 2017; 16: 1-9
- Conducting analysis in institutional ethnography: guidance and cautions.Int. J. Qual. Methods. 2017; 16: 1-11
- Australian Code for the Responsible Conduct of Research.2018
- RCM/RCOG Consensus Statement on Electronic Fetal Monitoring (EFM).2017
- Intrapartum Fetal Surveillance Clinical Guideline.4th ed. 2019
- Drivers of poor medical care.Lancet. 2017; 390: 178-190
- Impact of interruptions, distractions, and cognitive load on procedure failures and medication administration errors.J. Nurs. Care Qual. 2017; 32: 309-317
- Evaluating the effect of distractions in the operating room on clinical decision-making and patient safety.Surg. Endosc. 2016; 30: 4499-4504
- Disruptive behaviour in the perioperative setting: a contemporary review.Can. J. Anaesth. 2017; 64: 128-140
- The impact of rudeness on medical team performance: a randomized trial.Pediatr. 2015; 136: 487-495
- Trauma and fear in Australian midwives.Women Birth. 2018; 32: 64-71
- Factors affecting midwives’ confidence in intrapartum care: a phenomenological study.Midwifery. 2015; 31: 170-176
- Speaking up for patient safety by hospital health care professionals: a literature review.BMC Health Serv. Res. 2014; 14: 1-8
- Qualitative study of women’s experiences of safe childbirth in maternity care.Nurs. Health Sci. 2018; 20: 331-337
- Sources, responses and moderators of childbirth fear in Australian women: a qualitative investigation.Midwifery. 2015; 31: 239-246
- Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study.BMJ Open. 2017; 7e013413
- Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery.BJOG. 2012; 119: 1238-1246
- Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care.National Partnership for Women and Families, 2015
- The effects of decreasing maternal anxiety on fetal oxygenation and nucleated red blood cells count in the cord blood.Iran. J. Pediatr. 2014; 24: 286-292
- Mothers’ views of continuous electronic fetal heart monitoring and intermittent auscultation in a randomized controlled trial.Birth. 1985; 12: 79-86
- A biomechanical model of labour suggests that maternal freedom of movement is critical for a good birth.BJOG. 2018; 125: 894
- Balancing documentation and direct patient care activities: a study of a mature electronic health record system.Int. J. Indust. Ergon. 2019; 72: 338-346
- Veiled midwifery in the baby factory — a grounded theory study.Women Birth. 2018; 32: 80-86
- Implications of Perinatal Safety Nurse Fetal Monitoring Surveillance in the Labor and Delivery Setting [dissertation].Gardner-Webb University School of Nursing, Boiling Springs2012
- Rethinking the electronic health record through the quadruple aim: time to align its value with the health system.BMC Med. Inform. Decis. Mak. 2020; 20: 32
Article info
Publication history
Published online: June 03, 2021
Accepted:
May 20,
2021
Received in revised form:
April 18,
2021
Received:
September 23,
2020
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
