The Culture of Practising Intermittent Auscultation

Background: Intermittent auscultation is the recommended method of monitoring the fetal heart rate in labour for low risk pregnancies. The use of intermittent auscultation (IA) has been in decreased significantly since the... [ view full abstract ]

Background: Intermittent auscultation is the recommended method of monitoring the fetal heart rate in labour for low risk pregnancies. The use of intermittent auscultation (IA) has been in decreased significantly since the introduction of the cardiotocograph (CTG) in the 1960's. It was believed that the CTG would decrease perinatal morbidity and mortality rates, however, those rates have not declined as rapidly and drastically as expected. Evidence now exists to demonstrate that the use of the CTG as opposed to IA of the fetal heart rate for low risk labours actually increases instrumental birth and caesarean section rates.

Aims and Objectives: To describe midwives views and experiences of using IA of the fetal heart rate in labour. This poster focuses on organisational barriers as identified by the participating midwives using IA under the theme of ''the culture of the organisation".

Method: A qualitative descriptive study was conducted in an Irish urban obstetric-led maternity unit. A non-probability purposive sample consisted of eight midwives, five from the obstetric-led labour ward and three from the midwife-led DOMINO service. Data was collected through semi-structured interviews with thematic analysis resulting in 3 main themes. Ethical approval was received from the participating research site and the author's institution.

Findings: This poster presentation focuses on the second theme, 'the culture of the organisation' with two subthemes, 'medicalisation of labour' and 'the technology of industrialised birth'. This theme reflects the physical and psychological environment that the participating midwives work within and how it impacts on their ability to practise IA.

Conclusions and Implications: Working within a bio-medical model of care promotes the use of medical technology such as the CTG. Research evidence demonstrates that the use of the CTG to monitor the fetal heart rate in low risk pregnancies is inappropriate. Midwives that work in a midwifery model of care experience less exposure to medical technology thus promoting the practice of IA. Midwives should gain work experience in both models of care and understand the appropriate use of technology in childbirth.