Pregnant womens’ views about choice of intrapartum monitoring of the fetal heart rate: A questionnaire survey
Section snippets
What is already known about the topic?
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There is a dearth of literature pertaining to womens’ choices around the use of intrapartum fetal monitoring techniques.
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Little is known about current preferences for intrapartum fetal monitoring techniques.
What this paper adds
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Current practices in intrapartum fetal monitoring are not based on best evidence whereby women at low obstetric risk are routinely monitored by electronic means.
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Women expect to be monitored by high-tech means despite their low-risk status.
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Choice and control are complex concepts that are difficult to measure. For example, despite the fact that the majority of women reported that they had not been offered a choice of monitoring method, they also reported that they felt they had received an
Aim
The aim of this study was to ascertain womens’ views on intrapartum fetal monitoring techniques and informed choice. This was only one aspect of a larger study that appraised intrapartum fetal monitoring guidelines in one region and investigated midwives’, views on the use of intrapartum fetal monitoring techniques. This paper will report the findings from the surveys of pregnant womens’ views.
Design
An exploratory, descriptive approach was used via surveys of 63 pregnant women at low obstetric risk in the antepartum period, and 38 of these women also completed a postpartum survey. This was conducted using a questionnaire.
The participants
All of the 63 pregnant women considered to be at low obstetric risk approached in the antepartum period agreed to participate. The sample was spread across two hospital providers of maternity services (center 1, n=30 and center 2, n=33). Only women with no underlying
Results
Demographic characteristics of the respondents are presented in Table 1, Table 2.
The results are from the antepartum and postpartum questionnaires and are organized into four main themes: womens’ preferences for intrapartum-monitoring methods and mobility, decision-making/decision role preferences, choice/control and sources of information. The general obstetric population for the two hospitals was similar across the Trusts; there was an equal split in terms of first pregnancies and those with
Discussion
The use of the term “technology” is defined for the purposes of this discussion as: the use of procedures and equipment for the purpose of achieving definite, measurable outcomes. In this study, 56% of pregnant women in the antepartum survey wanted to receive EFM in labor despite this method being the most technologically invasive and that there were no medical/obstetric indications for this. Results from the postpartum survey indicated that 61% of women had some form of EFM with 53% receiving
Further research
It is important to establish whether women share a consensus of what active decision-making roles actually entail. With this in mind, it would be useful to examine on a larger scale the roles and perceptions women have when engaging in making choices around the use of fetal monitoring in labor. Similarly, it would be useful to observe the interactions between women and midwives as lead carers for women in childbirth when informed choice is being implemented.
Limitations
Due to the small sample this is a descriptive study and as such power analysis was not required. The women sampled across the two NHS sites were demographically comparable, however, they were all white and despite our efforts we were unable to include a sample of Asian, immigrant women as our access to them was blocked by a number of gatekeepers including an Asian GP and some midwives. We believe we could have increased the response rate in the postpartum survey by re-contacting the respondents
Conclusion
The survey was only one aspect of a larger study but it shows that choice and decision making are important factors for women where intrapartum monitoring of the fetal heart is concerned. The findings indicate that the environment does influence womens’ preferred decision-making roles as passive roles increase during labor where women place the midwife's decision above their own preferences.
It has been shown that despite midwives espousing a woman-centered care philosophy; where technology is
Acknowledgments
We thank the NHS, Northern region Research and Development Directorate, which financed the whole study. We also thank the women who participated in the survey who despite the demands of their personal and working lives, found the time to complete the questionnaires. We also thank the NHS maternity units that facilitated access for the study.
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