Amendments in electronic fetal monitoring and intermittent auscultation

Interpretation of cardiotocography (CTG) remains a controversial topic, despite attempts by the national professional bodies to standardise the terminology and decision-making systems. The National Institute for Health and Care Excellence (NICE, 2014) had the difficult and unenviable task of formulating guidelines given the dearth of good-quality evidence. In some ways, it would be better to have a separate guideline for intrapartum fetal monitoring—as in many other countries—because it is a major specialist subject in itself. This would allow many more specialists with a focused, specific interest and expertise in CTG to be on the panel.

Midwives are, of course, at the frontline of CTG interpretation and intermittent auscultation of fetal heart rate (FHR) during labour—hence they bear the brunt of any major changes and shortcomings of the guidelines. Their CTG interpretation practice has come under increasing scrutiny and regulation, making it one of the leading causes of strain and pressure of the job. Not only do different countries have varying 3-tier systems of CTG interpretation and recommendations, the UK guidelines have themselves undergone significant change (NICE, 2007; 2014). It is worth considering the validity of these changes, implications for midwives and whether midwives should take a more active role in influencing changes in future. British midwives have always been trained to interpret a combination of different FHR parameters in the context of the clinical picture and risk factors, but this remains a complex judgement. This commentary will focus on the interpretation of FHR decelerations (considered centre-stage) on CTG and intermittent auscultation, where there have been amendments in recent years (NICE, 2014).