Intermittent Auscultation versus Continuous Fetal Monitoring

Peer-Reviewed Article: Intermittent Auscultation versus Continuous Fetal Monitoring

Patey, Curran, Sprague, Francis, Driedger, Légaré, and Grimshaw (2017), in their article, compare intermittent auscultation (IA), a most recommended approach to fetal surveillance in the labor ward for healthy women, against continuous electrical fetal monitoring (EFM). The researchers adopted a semi-structured interview method for birthing unit nurses in Ontario, Canada, to collect and analyze their views concerning AI and EFM for fetal surveillance during labor and birth. Intermittent auscultation uses an instrument to listen to fetal heart rates (FHR) through the mother’s abdomen for short periods. In many cases, the caregiver may use a portable or external handheld transducer to listen instantly following a contraction for 1 minute, every 15-30 minutes in active labor, and at a frequency of 5 minutes in the active part of the second stage. As defined in the article, electronic fetal monitoring refers to the concurrent application of ultrasound transducers and toco-transducers to measure the duration and frequency of contractions for intermittent periods or continuously throughout the labor. EFM’s original purpose was to offer an early indication of fetal distress or stress that needs quick obstetric interventions to ensure the safety of the fetus. However, the researchers noted that the use of EFM has resulted in a surge in maternal morbidities because of unnecessary medical interventions, including cesarean section, without decreasing newborn/fetal morbidities. 

In a systematic review, Patey et al. further noted that continuous EFM is characterized by higher rates of operation virginal and cesarean sections deliveries, and many women report lower satisfaction with their birthing experience. EFM is also linked to 70% of all legal cases and claims relating to intrapartum care, particularly concerning children who suffered a brain injury because of inconsistent interpretation of recordings by physicians and nurses. However, despite the adverse outcomes, EFM is more applied by medical professionals than IA. In the Patey et al.’s interview of 12 birthing nurses, the participants reported time constraints, competing tasks, and the need to multitask as the primary factors limiting the nurses’ ability to conduct IA; hence the preference for EFM. Some nurses reported that the decision to apply IA is something they often consciously think about their patients, while others argued it is their default choice provided there are no potential risk factors. The nurses cited positive outcomes of IA, including mother-centered care, avoidance of unnecessary interventions, and some negative consequences, including legal concerns. Some nurses argued that varying support from the caregiving teams and hospital policies introverted their application of IA. They believed that support from the hospital management and care teams could increase the nurses’ preferences for AI.

The article shows that the potential influence of nurses’ adoption of intermittent auscultation as a primary approach to fetal surveillance is primarily behavioral issues emanating from domains beliefs concerning capabilities, resources, and environmental context, and belief about the consequences and social influences. Such beliefs point to the need for behavior change interventions to encourage IA application. The hospital management and care teams can promote nurses’ positive perception of IA by providing the resources and support systems necessary to use IA interventions. Such include increasing the workforce to save nurses from multitasking and provide ample time to conduct IA. Even though many nurses and hospitals prefer EFM because it is easy to initiate and offer precise readings/results from the printouts, interpretations of EFM results are subject to inconsistency between observers, which is risky for the mother and fetus or newborn.

Reference

Patey, A. M., Curran, J. A., Sprague, A. E., Francis, J. J., Driedger, S. M., Légaré, F., … & Grimshaw, J. M. (2017). Intermittent auscultation versus continuous fetal monitoring: exploring factors that influence birthing unit nurses’ fetal surveillance practice using theoretical domains framework. BMC pregnancy and childbirth, 17(1), 1-18.