“I'm not doing what I should be doing as a midwife”: An ethnographic exploration of central fetal monitoring and perceptions of clinical safety

Kirsten A. Small, Mary Sidebotham, Jennifer Fenwick, Jenny Gamble

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)193-200
Number of pages8
JournalWomen and Birth
Volume35
Issue number2
Early online date4 Jun 2021
DOIs
Publication statusPublished - Mar 2022
Externally publishedYes

Bibliographical note

Funding Information:
This research was supported by Higher Degrees by Research funding from Griffith University , a Griffith Graduate Research School Completion Scholarship , and a travel grant from the same organisation which facilitated travel to a conference. There was no industry sponsorship of this research.

Publisher Copyright:
© 2021 Australian College of Midwives

Keywords

  • Behaviour
  • Cardiotocography
  • Central monitoring
  • Electronic fetal monitoring
  • Parturition
  • Safety

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Maternity and Midwifery

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