Focus on the beat: current fetal monitoring practice in low risk labour

Lewis, Lucy; Rowe, Jennifer

doi:10.1016/s1448-8272(04)80029-4

Cited by 4 publications

(6 citation statements)

References 22 publications

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“…Many barriers exist preventing nurses from implementing IA during the intrapartum period (Graham, Logan, Davies, & Nimrod, 2004;Lewis & Rowe, 2004;Rattray, Flowers, Miles, & Clarke, 2011;Regan & Liaschenko, 2007;Sleutel, Schultz, & Wyble, 2007). The purpose of this article is to review the history of fetal monitoring; address factors influencing the fetal heart rate during labor; report on the different types of fetal monitoring available; discuss barriers identified in the literature inhibiting the implementation of fetal monitoring choice in childbirth; and provide suggestions to incorporate evidence-based material into childbirth classes.…”

Section: Different Types Of Fetal Monitoringmentioning

confidence: 99%

“…Fear of litigation is often mentioned as a reason for EFM (Chalmers et al, 2009;Lewis & Rowe, 2004); however, in reality, obstetric malpractice claims have risen as cesarean surgeries have gone up (Clark, Belfort, Byrum, Meyers, & Perlin, 2008). When detailed and highly specific protocols with effective peer review were initiated at the Hospital Corporation of America, cesarean surgeries fell and malpractice claims plummeted (Clark et al, 2008).…”

Section: Malpracticementioning

confidence: 99%

“…Barriers to informed choice include a midwife's belief that technology enhanced her professional status and was of higher value than her intuitive knowledge and skills; the labor unit being too busy to have conversations about EFM; and fear of litigation (Hindley & Thomson, 2005;Lewis & Rowe, 2004).…”

Section: Informed Choicementioning

confidence: 99%

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Fetal Monitoring: Creating a Culture of Safety With Informed Choice

Heelan¹

2013

J Perinat Educ

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The dominant culture in labor and birth is the medical model, not the midwifery model of woman-centered care. Consensus among professional and governmental groups is that, based on the evidence, intermittent auscultation is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM). Barriers impact the laboring woman's ability to give informed choice regarding fetal monitoring. Lack of informed choice denies a woman her right to be in control of her birth experience, and is in opposition to a woman's right to autonomy and self-determination.

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Section: Different Types Of Fetal Monitoringmentioning

confidence: 99%

Section: Malpracticementioning

confidence: 99%

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Fetal Monitoring: Creating a Culture of Safety With Informed Choice

Heelan¹

2013

J Perinat Educ

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“…FHRM is a method that helps to identify the early signs of fetal hypoxia; which may help to prevent stillbirth, early neonatal death, and long-term physical or mental disability by allowing healthcare providers to intervene [ 6 , 7 ]. The preferred method of FHRM in low-risk labor is intermittent auscultation [ 8 , 9 ]. However, there is a paucity of evidence regarding the effect of varying auscultation frequencies on intrapartum outcomes [ 7 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Inadequate fetal heart rate monitoring and poor use of partogram associated with intrapartum stillbirth: a case-referent study in Nepal

Wrammert

Clark

et al. 2016

BMC Pregnancy Childbirth

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BackgroundNewborns are at the greatest risk for dying during the intrapartum period, including labor and delivery, and the first day of life. Fetal heart rate monitoring (FHRM) and partogram use to track labor progress are evidence-based techniques that can help to identify maternal and fetal risk factors so that these can be addressed early. The objective of this study was to assess health worker adherence to protocols for FHRM and partogram use during the intrapartum period, and to assess the association between adherence and intrapartum stillbirth in a tertiary hospital of Nepal.MethodsA case-referent study was conducted over a 15-month period. Cases included all intrapartum stillbirths, while 20 % of women with live births were randomly selected on admission to make up the referent population. The frequency of FHRM and the use of partogram were measured and their association to intrapartum stillbirth was assessed using logistic regression analysis.ResultsDuring the study period, 4,476 women with live births were enrolled as referents and 136 with intrapartum stillbirths as cases. FHRM every 30 min was only completed in one-fourth of the deliveries, and labor progress was monitored using a partogram in just over half. With decreasing frequency of FHRM, there was an increased risk of intrapartum stillbirth; FHRM at intervals of more than 30 min resulted in a four-fold risk increase for intrapartum stillbirth (aOR 4.17, 95 % CI 2.0–8.7), and the likelihood of intrapartum stillbirth increased seven times if FHRM was performed less than every hour or not at all (aOR 7.38, 95 % CI 3.5–15.4). Additionally, there was a three-fold increased risk of intrapartum stillbirth if the partogram was not used (aOR 3.31, 95 % CI 2.0–5.4).ConclusionThe adherence to FHRM and partogram use was inadequate for monitoring intrapartum progress in a tertiary hospital of Nepal. There was an increased risk of intrapartum stillbirth when fetal heart rate was inadequately monitored and when the progress of labor was not monitored using a partogram. Further exploration is required in order to determine and understand the barriers to adherence; and further, to develop tools, techniques and interventions to prevent intrapartum stillbirth.Clinical trial registrationISRCTN97846009.

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“…Consequently, the optimum development of innovative tools to improve the quality of intrapartum monitoring depends on understanding both FLHWs' current practices, and their views on the challenges and opportunities in this area. 7,8 Previous qualitative studies in this area conducted among health professionals have generally focused on specific aspects of intrapartum assessments, such as the monitoring of fetal heart rate, [9][10][11][12] use of the partograph, 13 and labor monitoring provided to a particular subgroup of women, or by a certain cadre of health workers. 7,8,14 In particular, use of the partograph for labor monitoring is problematic: studies conducted in Nigeria concluded that the lack of knowledge about and training in the use of this tool limited the correct use and often resulted in nonuse among health workers.…”

Section: Introductionmentioning

confidence: 99%

Healthcare providers’ perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities

Yang

Bohren

Kyaddondo

et al. 2017

Intl J Gynecology & Obste

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Objective: To explore current practices, challenges, and opportunities in relation to monitoring labor progression, from the perspectives of healthcare professionals in low-resource settings. Methods Conclusion:Healthcare providers face many challenges to effective monitoring of labor progress in low-resource settings. This analysis presents potential opportunities to improve labor monitoring practices and tools in these contexts. K E Y W O R D S

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Focus on the beat: current fetal monitoring practice in low risk labour

Cited by 4 publications

References 22 publications

Fetal Monitoring: Creating a Culture of Safety With Informed Choice

Fetal Monitoring: Creating a Culture of Safety With Informed Choice

Inadequate fetal heart rate monitoring and poor use of partogram associated with intrapartum stillbirth: a case-referent study in Nepal

Healthcare providers’ perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities

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