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Aanstad KJ, Pripp AH, Dalbye R, Pay AD, Staff AC, Kaasen A, Blix E. Intrapartum fetal monitoring practices in Norway: A population-based study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:101006. [PMID: 38986340 DOI: 10.1016/j.srhc.2024.101006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE To describe intrapartum fetal monitoring methods used in all births in Norway in 2019-2020, assess adherence to national guidelines, investigate variation by women's risk status, and explore associations influencing monitoring practices. METHODS A nationwide population-based study. We collected data about all pregnancies with a gestational age ≥ 22 weeks during 2019-2020 from the Medical Birth Registry of Norway. We used descriptive analyses, stratified for risk status, to examine fetal monitoring methods used in all deliveries. Univariable and multivariable logistic regression models were used to determine factors associated with monitoring with cardiotocography (CTG) in low-risk, straightforward births. RESULTS In total, 14 285 (14%) deliveries were monitored with only intermittent auscultation (IA), 46214 (46%) with only CTG, and 33417 (34%) with IA and CTG combined. Four percent (2 067/50 533) of women with risk factors were monitored with IA only. Half (10589/21 282) of the low-risk women with straightforward births were monitored with CTG. Maternal and fetal characteristics, size of the birth unit and regional practices influenced use of CTG monitoring in this group. CONCLUSIONS Most births are monitored with CTG only, or combined with IA. Half the women with low-risk pregnancies and straightforward births were monitored with CTG although national guidelines recommending IA.
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Affiliation(s)
- Kristin Jerve Aanstad
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Rebecka Dalbye
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Department of Gynaecology and Obstetrics, Østfold Hospital Trust, Grålum, Norway
| | - Aase Devold Pay
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Department og Gynecology and Obstetrics, Vestre Viken Hospital Trust, Bærum, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Kaasen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ellen Blix
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
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Striebich S, Bauer NH, Dietze-Schwonberg K, Grieshop M, Kluge-Bischoff A, Zyriax BC, Plappert CF. Academic education of midwives in Germany (part 2): Opportunities and challenges for the further development of the profession of midwifery. Position paper of the Midwifery Science Committee (AHW) in the DACH Association for Medical Education (GMA). GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc32. [PMID: 39131891 PMCID: PMC11310788 DOI: 10.3205/zma001687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 08/13/2024]
Abstract
The objective of academic training is to prepare midwives as independent healthcare professionals to make a substantial contribution to the healthcare of women in their reproductive years as well as to the health of their children and families. This article therefore describes the professional and educational requirements derived from the legal midwifery competencies within the new midwifery act. Furthermore, it identifies the conditions that need to be established to enable midwives in Germany to practise to their full scope in compliance with statutory responsibilities. Educational science, academic efforts, policymaking and accompanying research should work in synergy. This in turn enables midwives to achieve the maximum scope of their skills, with the objective of promoting physiological pregnancies and births. Consequently, it can strengthen early parenthood in alignment with the national health objectives of "health around childbirth". The academisation of the midwifery profession presents a profound opportunity for professional development in Germany. It is essential that midwives receive training based on the principles of educational science and care structures that are yet to be developed. This can enable them to perform within the wide range of their professional tasks to the highest standards, thereby ensuring the optimal care of their clients. Moreover, there is a chance to implement sustainable improvements in healthcare provision for women and their families during the reproductive phase and the period of parenthood in Germany.
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Affiliation(s)
- Sabine Striebich
- Martin Luther University Halle-Wittenberg, University Medicine Halle, Medical Faculty, Institute of Health and Nursing Science, Halle (Saale), Germany
| | - Nicola H. Bauer
- University of Cologne and University Hospital Cologne, Medical Faculty, Institute for Midwifery Science, Cologne, Germany
| | | | - Melita Grieshop
- Protestant University of Applied Sciences Berlin, Berlin, Germany
| | | | - Birgit-Christiane Zyriax
- University Medical Center Hamburg-Eppendorf, Midwifery Science – Health Services Research and Prevention,Institute for Health Services Research in Dermatology and the Nursing Professions (IVDP), Hamburg, Germany
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Hatamleh R, Al-Akour N, Maharmeh SM, Atout M. Midwives' attitudes toward the use of cardiotocograph (CTG) machines in labor units: A study in Jordan. Midwifery 2024; 132:103978. [PMID: 38555829 DOI: 10.1016/j.midw.2024.103978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/09/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The purpose of cardiotocograph (CTG) usage is to detect any alterations in fetal heart rate (FHR) early before they are prolonged and profound. However, the use of CTG machines on a routine basis is not an evidence-supported practice. There is no Jordanian study that assesses the midwives' attitudes toward this machine. This study aimed to identify Jordanian midwives' attitudes towards the use of cardiotocograph (CTG) machines in labor units, alongside examining the relationships between midwives' personal sociodemographic characteristics and such attitudes. METHODS A descriptive research design was used to identify Jordanian midwives' attitudes towards the use of CTG machines in both public and private labor units in Jordan. Data were collected using the valid and reliable tool designed by Sinclair (2001), and these were used to identify midwives' attitudes towards CTG usage. A total of 329 midwives working in the labor units of governmental and private hospitals in the center and north of Jordan participated in the study from May to July 2022. RESULTS The total mean score for the attitude scale was M = 3.14 (SD = 0.83). More than half of the sample (N = 187, 58.4 %) demonstrated a mean score greater than 3.14, however, which indicates generally positive attitudes toward CTG usage in labor units. Midwives working in private hospitals and those holding Bachelor's degrees had more positive attitudes toward the use of CTG machines. CONCLUSION This study provides new insights into the attitudes of Jordanian midwives towards CTG use in labor units. These suggest that it is critical to conduct training courses for registered midwives to help them develop and/or regain confidence and competence with respect to various key aspects of intrapartum care, including intermittent auscultation and the appropriate use of CTG.
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Affiliation(s)
- Reem Hatamleh
- Faculty of Nursing, Jordan University of Science and Technology, P.O.BOX 3030, Irbid 22110, Jordan
| | - Nemeh Al-Akour
- Faculty of Nursing, Jordan University of Science and Technology, P.O.BOX 3030, Irbid 22110, Jordan
| | - Suha M Maharmeh
- Faculty of Nursing, Jordan University of Science and Technology, P.O.BOX 3030, Irbid 22110, Jordan
| | - Maha Atout
- Faculty of Nursing, Philadelphia University, Jarash Road, P.O. Box 19392, Amman, Jordan.
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. J Obstet Gynecol Neonatal Nurs 2024; 53:e10-e48. [PMID: 38363241 DOI: 10.1016/j.jogn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. Nurs Womens Health 2024; 28:e1-e39. [PMID: 38363259 DOI: 10.1016/j.nwh.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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De Vries R, de Jonge A, Declercq E. The responsibility of the drafters of the Ockenden report to ensure their data are not mispresented. BJOG 2023. [PMID: 36938667 DOI: 10.1111/1471-0528.17450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/09/2023] [Indexed: 03/21/2023]
Affiliation(s)
- R De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - A de Jonge
- Midwifery Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - E Declercq
- Boston University School of Public Health, Boston, Massachusetts, USA
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Kelly P, Quance M, Snow N, Porr C. Using Institutional Ethnography to Explicate the Everyday Realities of Nurses' Work in Labor and Delivery. Glob Qual Nurs Res 2022; 9:23333936221137576. [PMID: 36451627 PMCID: PMC9703482 DOI: 10.1177/23333936221137576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/05/2024] Open
Abstract
Fetal health surveillance is a significant everyday work responsibility for labor and delivery nurses. Here, nursing care is increasingly focused on technological interventions, particularly with the use of continuous electronic fetal monitoring. Using Institutional Ethnography, we explored how nurses conduct this work and uncovered the ruling relations coordinating how nurses "do" fetal health surveillance. Analysis revealed how these powerful ruling relations associated with the biomedical and medical-legal discourses coordinated nurses' fetal monitoring work. Forms requiring documentation of biophysical data caused nurses to focus on technological interventions with much less attention given to holistic and supportive care measures. In doing so, nurses inadvertently activated and participated in these powerful ruling discourses. The practice of ensuring the safe birth of the baby through advances in technological surveillance and medical interventions took priority over well-established approaches to holistic nursing care.
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Affiliation(s)
- Paula Kelly
- Memorial University of Newfoundland in St. John’s, Canada
| | | | - Nicole Snow
- Memorial University of Newfoundland in St. John’s, Canada
| | - Caroline Porr
- Memorial University of Newfoundland in St. John’s, Canada
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The overuse of intrapartum cardiotocography (CTG) for low-risk women: An actor-network theory analysis of data from focus groups. Women Birth 2022; 35:593-601. [DOI: 10.1016/j.wombi.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/02/2022] [Accepted: 01/08/2022] [Indexed: 11/20/2022]
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Dal Cin S, Low LK, Lillvis D, Masten M, De Vries R. What Do Women Want? Consent for the Use of Electronic Fetal Monitoring. INTERNATIONAL JOURNAL OF CHILDBIRTH 2021. [DOI: 10.1891/ijcbirth-d-20-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDGuidelines published by professional associations of midwives, obstetricians, and nurses in the United States recommend against using continuous cardiotocography (CTG) in low-risk patients. In the United States, CTG or electronic fetal/uterine monitoring (EFM) rather than auscultation with a fetoscope or Pinard horn is the norm. Interpretation of the fetal heart rate (FHR) and uterine activity (UA) tracings provided by continuous EFM may be associated with the decision for a cesarean birth. Typically, consent is not sought in the decision about type of monitoring. No studies were identified where women's attitudes about the need to consent to the type of fetal monitoring used during labor have been explored. Therefore, the purpose of this research was to examine women's attitudes about the use of EFM in a healthcare setting.METHODSWe asked a sample of women aged 18–50 years to respond to one of three monitoringscenarios. The scenarios were used to distinguish between attitudes about monitoring in general, monitoring the health of a mother in labor, and monitoring the health of the fetus during labor. Wemeasured their level of interest in being monitored and their opinions about whether healthcare providers should be required to obtain consent for the monitoring described in the scenario.RESULTSInterest in receiving monitoring (across all three scenarios) was moderate, with the highest level of interest in monitoring the fetus during labor and the least interest in monitoring a general health context. Across all scenarios, 82% of respondents believed that practitioners should obtain consent for monitoring, 14% were unsure, and 4% said there should not be a requirement for consent. While low (6%), the percentage responding that consent was not needed was highest in monitoring a fetus in labor.CONCLUSIONSWomen in our study expressed a strong preference for the opportunity to consent to the use of monitoring regardless of the healthcare scenario. There is findings suggest the need for further research exploring what women do and do not know about CTG and what their informed performance are a pressing need to rethink the role of a pressing need to rethink the role of shared decision-making and informed consent about the type of monitoring use during labor.
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Romano AM, Buxton M. A Multimethod Improvement Project to Strengthen Intermittent Auscultation Practice Among Nurse-Midwives and Nurses. J Midwifery Womens Health 2020; 65:362-369. [PMID: 32424909 DOI: 10.1111/jmwh.13113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/28/2020] [Accepted: 03/08/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Intermittent auscultation (IA) is an accepted standard of care for intrapartum fetal assessment for low-risk individuals and is the exclusive method used to monitor fetal status in birth centers. However, there are conflicting national guidelines for practice and skill training. As a result, IA technique and skills vary across the perinatal care workforce, with many health care providers receiving no or minimal formal training. This article describes the design, implementation, and evaluation of a quality improvement program aimed at strengthening the IA skills of nurse-midwives and nurses. PROCESS The project was implemented in a multisite network of freestanding birth centers and involved clinical practice guideline development, simulation-based training, audit and feedback, in-person training, and electronic health record configuration. OUTCOMES The training resulted in self-reported increases in knowledge in all areas assessed. The integrated quality improvement initiative resulted in substantial improvements in consistency of practice and documentation. DISCUSSION Policy change was not sufficient to improve use of IA, a nuanced skill that many midwives and nurses have limited exposure to in basic education programs and hospital-based clinical practice. Clinical improvement was possible when the policy change was accompanied by a comprehensive training and implementation strategy including interactive, simulation-based learning, audit and feedback, and an electronic health record configuration that better reflected the documentation standards.
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Affiliation(s)
- Amy M Romano
- Independent Quality Improvement Consultant, Milford, Connecticut
| | - Margaret Buxton
- Baby and Company, Vanderbilt University School of Nursing, Nashville, Tennessee
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