Electronic Fetal Monitoring: A Case Study

Complications in pregnancy
Assignment 1: Part B

How can midwives maintain women centered care and promote autonomy when a woman is undergoing Electronic Fetal Monitoring (EFM)?

What is EFM and why should it be women’s centered?

Electronic Fetal Monitoring

There are three main ways to monitor fetal well-being, the first being an external cardiotocography (CTG) which continually monitors both fetal heart rate and maternal uterine contractions. (Department of Health 2013) Another external form of fetal monitoring is intermittent auscultation (use of a Doppler) and lastly an internal fetal monitor known as a fetal scalp electrode. This is a wire that is connected to the skin on the fetal scalp; if applied correctly it picks up the heart rate and records the trace onto the CTG paper similar to the external transducer. (Pairman, S. Tracy, S. Thorogood, C, & Pincombe, J 2015) Fetal monitoring is extremely important to limit and/or minimize adverse fetal outcomes. (Department of Health 2013)

Women Centred Care

Everything that is done antenatally, intrapartum and postpartum has to be completed in partnership with the woman. (Nursing and Midwifery Board of Australia, 2008) An important part of being a midwife is having a firm understanding that we have a

huge responsibility to advocate for the woman and provide her with the opportunity to make informed choices. (Fahy, K 2012) The opposite of this, is lack of information and disallows the woman her human right to control her labour and birth experience. (Fahy, K 2012)

How can we make things Women Centred?

Intermittent auscultation is a standard protocol in most hospitals for women in low risk/normal labour.

(Heelan, L 2013) A Doppler is applied to the woman’s abdomen every 15-30 minutes to monitor baby’s heart rate; none of the above is done without the mother consent. The midwife simply explains the process of intermittent auscultation, why it is important the midwife is allowed to do it and finally asking for the woman’s consent. (Department of Health 2013) This is the perfect way for the mother to feel in control of her labour and an opportunity to use her autonomy. A very simple but powerful way to include her in what is a standard protocol; the same thing can also be done for the CTG or the fetal scalp

electrode.

According to the Perinatal Practice Guidelines, when a woman is in normal labour a continuous CTG is not necessary, it is only needed on women with more complex circumstances. (Department of Health 2013) Even when a woman requires a CTG, by way of hospital protocol, she has the right to decline. It is important that she is given the option, and that what happens is explained to her in a way she understands. CTG’s minimize the mobility of the woman and often stop her from things like a water birth. To increase her autonomy is by giving her the education and unbiased information to make the decision.

To help maintain the woman’s autonomy it is important to keep her aware of what is happening to both her and her baby. (Nursing and Midwifery Board of Australia, 2008) If a CTG or fetal scalp electrode is introduced to the labour an easy way to help keep her at ease is explaining what the readings are and inform her of the condition her baby appears to be in. The Nursing and Midwifery Board of Australia’s Code of Ethics expresses how imperative it is midwives work in partnership with the woman, thus achieving the desired result of an autonomous, empowered mother. (Nursing and Midwifery Board of Australia, 2008)