Fetal heart rate auscultation. Comparing auscultation to electronic fetal monitoring

Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women

Background

Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings.

Methods

A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session.

Results

Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60 – 0.95, p = 0.016).

Conclusion

The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women.

Maternal anxiety and feelings of control during labour: a study of Chinese first-time pregnant women

OBJECTIVE

to explore and examine the relationship between maternal anxiety levels and feelings of control during labour among Hong Kong Chinese first-time pregnant women.

DESIGN

an exploratory descriptive correlation design. Data were collected on three occasions: during latent phase of labour, during active phase of labour and within 24-48 hrs after delivery.

SETTING

an obstetric unit of a public teaching hospital in Hong Kong.

PARTICIPANTS

a convenience sample of 90 Hong Kong Chinese first-time mothers.

MEASUREMENTS AND FINDINGS

the Labour Agentry Scale (LAS) is a self-report scale designed to measure feelings of control during childbirth. A Visual Analogue Scale for anxiety (VAS-A) was used to measure women's self-reported level of anxiety during labour. Pearson Product Moment Correlation coefficient test indicated a significant negative relationship between the feelings of control and maternal anxiety during labour. No statistical relationships were detected between women's attendance at antenatal classes and feelings of control during labour.

KEY CONCLUSIONS

the study showed a significant negative relationship between maternal anxiety and feelings of control during labour.

IMPLICATIONS FOR PRACTICE

midwives should work with women to enhance their personal control during labour and satisfaction with their birth. The insignificant relationship between attendance at antenatal classes and feelings of control suggests the need to evaluate the content of childbirth education in order to empower women's control during labour.

Care practice #4: no routine interventions

This updated edition of Care Practice Paper #4 presents the evidence for risks of routinely intervening in normal physiologic labor and birth. The authors review evidence related to the routine use of restrictions on oral intake, intravenous lines, continuous electronic fetal monitoring, artificial rupture of membranes, pharmacologic augmentation of labor, epidural analgesia, and episiotomy. Medical indications for each intervention are listed. Women are encouraged to avoid routine interventions in labor unless interventions are medically indicated.

The theater of birth: scenes from women's scripts

An analogy between theater and birth is drawn from analyses of women's birth stories to describe birth from a fresh perspective. Birth and theater are compared using the theatrical production elements: setting, casting, props, set, behind the scenes, script, and roles. Selected examples from women's birth stories highlight each element. Nurses' roles are significant during labor and birth, but nurses' abilities to fulfill these roles are threatened. This analogy promotes rethinking of nursing actions in the theater of birth. Implications for clinical practice are provided, including altering the birth environment, offering choices, and maintaining the woman's role as star.