The social organisation of decision-making about intrapartum fetal monitoring: An Institutional Ethnography

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

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)281-289
Number of pages9
JournalWomen and Birth
Issue number3
Early online date18 Sept 2022
Publication statusPublished - May 2023


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.


  • Decision-making
  • Midwives
  • Obstetricians
  • Institutional Ethnography
  • Guidelines
  • Fetal monitoring

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Maternity and Midwifery


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