Helping student midwives become safe practitioners: effective teaching of cardiotocograph interpretation
It is crucial that, at the point of registration, midwives can competently interpret intrapartum cardiotocographs (CTGs). It is therefore important that practice assessors are confident teaching the safe and accurate interpretation of CTGs to the students they support. This paper uses a case study to examine how CTG interpretation can be taught most effectively. Humanistic learning theories can be used to create a psychologically safe-learning environment which is enjoyable for both the student and the practice assessor. Using a taxonomy of learning enables midwives to help the student develop higher order thinking skills, while understanding the learning style of that individual student allows midwives to incorporate tailored teaching in their clinical work. In addition to providing feedback, it is beneficial to encourage self-reflection and the student midwife's newly learned skills can be solidified by peer teaching.
The ‘Saving babies’ lives' care bundle identified effective fetal monitoring during labour as one of four key areas of care to reduce the number of stillbirths and early neonatal deaths in the UK (NHS England, 2016). Intrapartum cardiotocograph (CTG) interpretation is a key midwifery skill in which midwives must prove competency prior to registration and annually thereafter if caring for women in a birth setting (NHS England, 2016; Nursing and Midwifery Council [NMC], 2019). However, the most recent ‘Each baby counts’ report (Royal College of Obstetricians and Gynaecologists, 2019), which reviewed the care of women whose babies died or were severely disabled as a results of incidents occurring during term labour in 2017, found that CTG issues were a critical contributory factor in the care of 59% of cases in which different care may have affected outcomes. Similarly, the most recent perinatal confidential enquiry noted that ‘there were errors in the method, interpretation, escalation and response to fetal monitoring’ which were a contributing factor in several intrapartum deaths (Draper et al, 2017).
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