Practices and views on fetal heart monitoring: a structured observation and interview study
Article first published online: 17 MAR 2006
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 113, Issue 4, pages 409–418, April 2006
How to Cite
Altaf, S., Oppenheimer, C., Shaw, R., Waugh, J. and Dixon-Woods, M. (2006), Practices and views on fetal heart monitoring: a structured observation and interview study. BJOG: An International Journal of Obstetrics & Gynaecology, 113: 409–418. doi: 10.1111/j.1471-0528.2006.00884.x
- Issue published online: 5 MAY 2006
- Article first published online: 17 MAR 2006
- Accepted 18 January 2006.
- Fetal monitoring;
- quality and safety
Objective To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring.
Design Qualitative study.
Setting Large teaching hospital in the UK.
Sample Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades.
Methods Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software.
Main outcome measures Deviations from recommended practice in relation to fetal monitoring and insights into why these occur.
Results All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context.
Conclusion Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution.