Intrapartum fetal monitoring and the spectre of litigation: A qualitative study of midwives' views

Abstract

Purpose

The routine use of intrapartum electronic fetal monitoring (EFM) has resulted in an increased burden of operative and vaginal instrumental deliveries for women at low obstetric risk. Such modes of delivery increase maternal mortality and morbidity risks. This study aims to explore midwives' values, attitudes and beliefs when using intrapartum fetal monitoring techniques in clinical practice.

Design/methodology/approach

A total of 58 registered midwives across two NHS Trusts in one region in the north of England were interviewed using a qualitative approach.

Findings

Midwives attempted to manage the psychological burden of the threat from clinical negligence by using EFM. This meant that some midwives used electronic monitoring regardless of clinical need. Midwives lack confidence in the ability of EFM to accurately detect fetal compromise but are aware that the visual monitoring record is recognised as a valuable piece of legal evidence. The midwives' perceptions of professional self‐efficacy in seeking to avoid a claim in clinical negligence contributed to defensive practice. Research limitations/implications – The study was conducted in only two hospitals in one region of England; however the Trust demographics were similar and midwifery practice within the unit reflects national maternity standards of care.

Practical implications

Multidisciplinary strategies may be required to overcome barriers to the effective implementation of clinical guidelines where intrapartum fetal monitoring is concerned and Trust audit departments must undertake regular audit cycles in order to ascertain practice compliance with best evidence.

Originality/value

The paper provides information so that midwives' knowledge regarding the limitations of EFM can be improved.

Citation

Hindley, C. and Thomson, A.M. (2007), "Intrapartum fetal monitoring and the spectre of litigation: A qualitative study of midwives' views", Clinical Governance: An International Journal, Vol. 12 No. 4, pp. 233-243. https://doi.org/10.1108/14777270710828900