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.


METHODS
Qualitative study.


METHODS
Large teaching hospital in the UK.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Social Science Group, Department of Health Sciences, University of Leicester, Leicester, UK.
S
S
Altaf
C
C
Oppenheimer
R
R
Shaw
J
J
Waugh
M
M
Dixon-Woods
D001291:Attitude of Health Personnel; D015148:Cardiotocography; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008880:Midwifery / Q000193:education; D009721:Nurse Midwives / Q000193:education / Q000523:psychology*; D024802:Nurse's Role; D007744:Obstetric Labor Complications / Q000451:nursing; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011364:Professional Practice / Q000592:standards*