Abstract
Background
International guidelines recommend intrapartum cardiotocograph (CTG) monitoring for
women at risk for poor perinatal outcome. Research has not previously addressed how
midwives and obstetricians enable or hinder women’s decision-making regarding intrapartum
fetal monitoring and how this work is structured by external organising factors.
Aim
To examine impacts of policy and research texts on midwives’ and obstetricians’ work
with labouring women related to intrapartum fetal monitoring decision-making.
Methods
We used a critical feminist qualitative methodology known as Institutional Ethnography
(IE). The research was conducted in an Australian tertiary maternity service. Data
collection included interviews, observation, and texts relating to midwives’ and obstetricians’
work with the fetal monitoring system. Textual mapping was used to explain how midwives’
and obstetricians’ work was organised to happen the way it was.
Findings
CTG monitoring was initiated predominantly by midwives applying mandatory policy.
Midwives described reluctance to inform labouring women that they had a choice of
fetal monitoring method. Discursive approaches used in a national fetal surveillance
guideline, a Cochrane systematic review, and the largest randomised controlled trial
regarding CTG monitoring in labour generated and reproduced assumptions that clinicians,
not labouring women, were the appropriate decision-maker regarding fetal monitoring
in labour.
Discussion and conclusion
Guidelines structured midwives’ and obstetricians’ work in a manner that undermined
women’s participation in decisions about fetal monitoring method. Intrapartum fetal
monitoring guidelines should be critically reviewed to ensure they encourage and enable
midwives and obstetricians to support women to make decisions about intrapartum care.
Keywords
Abbreviations:
CTG (cardiotocograph), IE (Institutional Ethnography), RANZCOG (Royal Australian and New Zealand College of Obstetrics and Gynaecology)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 18, 2022
Accepted:
September 6,
2022
Received in revised form:
September 5,
2022
Received:
June 13,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
