The art of midwifery: lost to technology?

Midwives' and doctors' attitudes towards the use of the cardiotocograph machine

The appropriate use of the cardiotocograph (CTG) machine in the clinical setting is an issue of concern for midwives and doctors.

OBJECTIVE

To examine midwives and doctors attitudes towards the use of the CTG machine in labour ward practice.

BACKGROUND

this small study provides new insight into the attitudes of doctor and midwives towards the use of CTG.

DESIGN

An exploratory descriptive design that used a combination of qualitative and quantitative approaches. A valid and reliable tool designed by Sinclair (2001) was used to measure the attitudes of doctors and midwives towards CTG usage. In addition, follow-up semi-structured interviews with doctors and midwives were conducted.

SETTING

A maternity unit in Northern Ireland.

PARTICIPANTS

Participants selected had worked in the labour ward within the last year (n = 56 midwives; n = 19 doctors). Six midwives and two doctors were randomly selected to participate in the interviews.

FINDINGS

The study demonstrated a favourable disposition towards the use of CTG machines with 72.5% (n = 29) of respondents indicating that they viewed CTG technology positively and 87.5% (n = 25) indicating they were confident about their skill in interpreting CTG tracings. The majority of the respondents (60.0%, n = 24) felt that their training adequately prepared them for using CTGs. The illustrative accounts provided by the respondents demonstrated a predominant belief that CTG technology continues to have a role in monitoring and detecting abnormalities in the fetal heart rate but this role is limited by how well the CTG is used and interpreted. The interviews confirmed the data obtained from the questionnaires and revealed a number of professional needs and concerns relating to CTG usage.

IMPLICATIONS FOR PRACTICE

The implication of this study may be focused on addressing the training needs of students, newly qualified staff and regular updates for employed staff. There was some concern that this technology may be deskilling staff and therefore there is a need to improve confidence levels in using alternatives to this type of fetal monitoring.

Practices and views on fetal heart monitoring: a structured observation and interview study

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.

Midwives' attitudes to the use of the cardiotocograph machine

BACKGROUND

The literature would suggest that midwives' attitudes towards the use of birth technology are mainly focused around issues of "trust and dependence" yet there has been no published research to refute or substantiate these beliefs.

AIM

This paper reports on an empirical study that aimed to identify midwives' attitudes to technology usage in the labour ward and specifically the use of the cardiotocograph machine (CTG) for electronic foetal monitoring.

DESIGN

A postal survey was conducted and the questionnaire included a 25-item attitude scale, which was designed to assess attitudes towards the use of the CTG machine. All midwives (1086) on the United Kingdom Central Council register for Northern Ireland were surveyed. The data were factor analysed and compared using several categorical groupings including age, perceived skill, prior training with computers and trust in the machines.

RESULTS

The results indicate that midwives reject any notion of them being, or becoming, dependent on machines in their practice. However, midwives who trust machines are more disposed to their use and trust is affected by perceived competence.

CONCLUSION

The paper concludes with a recommendation for the future education of midwives to develop and maintain competence based craft skills in natural birth as well as high-tech birth.