title: Putting intelligent structured intermittent auscultation (ISIA) into practice.
abstract: BACKGROUND
  Fetal monitoring guidelines recommend intermittent auscultation for the monitoring of fetal wellbeing during labour for low-risk women. However, these guidelines are not being translated into practice and low-risk women birthing in institutional maternity units are increasingly exposed to continuous cardiotocographic monitoring, both on admission to hospital and during labour. When continuous fetal monitoring becomes routinised, midwives and obstetricians lose practical skills around intermittent auscultation. To support clinical practice and decision-making around auscultation modality, the intelligent structured intermittent auscultation (ISIA) framework was developed.
  
  
  OBJECTIVE
  The purpose of this discussion paper is to describe the application of intelligent structured intermittent auscultation in practice.
  
  
  CONCLUSIONS
  The intelligent structured intermittent auscultation decision-making framework is a knowledge translation tool that supports the implementation of evidence into practice around the use of intermittent auscultation for fetal heart monitoring for low-risk women during labour. An understanding of the physiology of the materno-utero-placental unit and control of the fetal heart underpin the development of the framework.
  
  
  CONCLUSIONS
  Intelligent structured intermittent auscultation provides midwives with a robust means of demonstrating their critical thinking and clinical reasoning and supports their understanding of normal physiological birth.
authors.affiliation: Graduate School of Nursing, Midwifery and Health Victoria University of Wellington, New Zealand P O Box 7625, Newtown, Wellington 6242, New Zealand. Electronic address: Robyn.Maude@vuw.ac.nz.
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Maude
authors.affiliation: Graduate School of Nursing, Midwifery and Health Victoria University of Wellington, New Zealand P O Box 7625, Newtown, Wellington 6242, New Zealand. Electronic address: Joan.Skinner@vuw.ac.nz.
authors.forename: Joan P
authors.initials: JP
authors.lastname: Skinner
authors.affiliation: Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney PO Box 123, Broadway, NSW 2007, Australia. Electronic address: Maralyn.Foureur@uts.edu.ac.
authors.forename: Maralyn J
authors.initials: MJ
authors.lastname: Foureur
mesh_terms: D001314:Auscultation / Q000379:methods*; D003657:Decision Making; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D006340:Heart Rate, Fetal; D006801:Humans; D007743:Labor, Obstetric; D008880:Midwifery; D011247:Pregnancy
keywords: Decision-making; Fetal monitoring; Intermittent auscultation; Knowledge dissemination tool; Midwifery