Who is in the centre? A qualitative study on midwives’ experience of working with central fetal monitoring system

Abstract

Background

Central fetal monitoring systems are widely used and assumed to improve perinatal outcomes. However, there is a lack of studies focusing on midwives’ experiences in maternity services where central fetal monitoring technologies have been introduced.

Aim

The aim is to describe midwives’ experiences of working in a birthing service where a central fetal monitoring system had been recently introduced.

Method

Qualitative descriptive design. Three focus groups interviews were conducted with 18 midwives in a birthing service of a teaching hospital in Iceland. Content analysis was used to analyse the data set.

Findings

The main themes were 'the screen affects everything' and 'the technology has come to stay'. Midwives experienced a sense of being under surveillance, and modified their documentation to meet the information needs of staff at the central monitoring station. Experiencing unrequested visits from obstetric staff challenged midwives’ self-confidence, particularly if they were new to practice. Midwives reported tension in balancing the conflicting demands of being continuously present with the labouring woman and freedom to leave the room. Feeling that CTG interpretation was now a shared responsibility with medical staff was perceived as positive, but also altered the way midwives and doctors collaborated.

Conclusions

Introducing central fetal monitoring technology affected the culture of the birthing service in ways that may shape midwives’ perception of being a “good midwife”. The relationship between midwifery professional standards and the beliefs embedded in birth technology should be considered critically, rather than accepting that the “technology has come to stay”.