The social organisation of decision-making about intrapartum fetal monitoring: An Institutional Ethnography.

Small, KA; Sidebotham, M; Fenwick, J; Gamble, J

The social organisation of decision-making about intrapartum fetal monitoring: An Institutional Ethnography.

Small, KA Sidebotham, M Fenwick, J

Gamble, J

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Women Birth, 2023, 36, (3), pp. 281-289
Issue Date:: 2023-05

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Field	Value	Language
dc.contributor.author	Small, KA
dc.contributor.author	Sidebotham, M
dc.contributor.author	Fenwick, J https://orcid.org/0000-0003-3556-1193
dc.contributor.author	Gamble, J
dc.date.accessioned	2024-03-13T23:50:18Z
dc.date.available	2022-09-06
dc.date.available	2024-03-13T23:50:18Z
dc.date.issued	2023-05
dc.identifier.citation	Women Birth, 2023, 36, (3), pp. 281-289
dc.identifier.issn	1871-5192
dc.identifier.issn	1878-1799
dc.identifier.uri	http://hdl.handle.net/10453/176661
dc.description.abstract	BACKGROUND: International guidelines recommend intrapartum cardiotocograph (CTG) monitoring for women at risk for poor perinatal outcome. Research has not previously addressed how midwives and obstetricians enable or hinder women's decision-making regarding intrapartum fetal monitoring and how this work is structured by external organising factors. AIM: To examine impacts of policy and research texts on midwives' and obstetricians' work with labouring women related to intrapartum fetal monitoring decision-making. METHODS: We used a critical feminist qualitative methodology known as Institutional Ethnography (IE). The research was conducted in an Australian tertiary maternity service. Data collection included interviews, observation, and texts relating to midwives' and obstetricians' work with the fetal monitoring system. Textual mapping was used to explain how midwives' and obstetricians' work was organised to happen the way it was. FINDINGS: CTG monitoring was initiated predominantly by midwives applying mandatory policy. Midwives described reluctance to inform labouring women that they had a choice of fetal monitoring method. Discursive approaches used in a national fetal surveillance guideline, a Cochrane systematic review, and the largest randomised controlled trial regarding CTG monitoring in labour generated and reproduced assumptions that clinicians, not labouring women, were the appropriate decision-maker regarding fetal monitoring in labour. DISCUSSION AND CONCLUSION: Guidelines structured midwives' and obstetricians' work in a manner that undermined women's participation in decisions about fetal monitoring method. Intrapartum fetal monitoring guidelines should be critically reviewed to ensure they encourage and enable midwives and obstetricians to support women to make decisions about intrapartum care.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Women Birth
dc.relation.isbasedon	10.1016/j.wombi.2022.09.004
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.subject.classification	3215 Reproductive medicine
dc.subject.classification	4204 Midwifery
dc.subject.mesh	Pregnancy
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Australia
dc.subject.mesh	Labor, Obstetric
dc.subject.mesh	Midwifery
dc.subject.mesh	Fetal Monitoring
dc.subject.mesh	Anthropology, Cultural
dc.subject.mesh	Humans
dc.subject.mesh	Fetal Monitoring
dc.subject.mesh	Midwifery
dc.subject.mesh	Pregnancy
dc.subject.mesh	Labor, Obstetric
dc.subject.mesh	Anthropology, Cultural
dc.subject.mesh	Australia
dc.subject.mesh	Female
dc.subject.mesh	Pregnancy
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Australia
dc.subject.mesh	Labor, Obstetric
dc.subject.mesh	Midwifery
dc.subject.mesh	Fetal Monitoring
dc.subject.mesh	Anthropology, Cultural
dc.title	The social organisation of decision-making about intrapartum fetal monitoring: An Institutional Ethnography.
dc.type	Journal Article
utslib.citation.volume	36
utslib.location.activity	Netherlands
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	closed_access	*
dc.date.updated	2024-03-13T23:50:16Z
pubs.issue	3
pubs.publication-status	Published
pubs.volume	36
utslib.citation.issue	3

Abstract:

BACKGROUND: International guidelines recommend intrapartum cardiotocograph (CTG) monitoring for women at risk for poor perinatal outcome. Research has not previously addressed how midwives and obstetricians enable or hinder women's decision-making regarding intrapartum fetal monitoring and how this work is structured by external organising factors. AIM: To examine impacts of policy and research texts on midwives' and obstetricians' work with labouring women related to intrapartum fetal monitoring decision-making. METHODS: We used a critical feminist qualitative methodology known as Institutional Ethnography (IE). The research was conducted in an Australian tertiary maternity service. Data collection included interviews, observation, and texts relating to midwives' and obstetricians' work with the fetal monitoring system. Textual mapping was used to explain how midwives' and obstetricians' work was organised to happen the way it was. FINDINGS: CTG monitoring was initiated predominantly by midwives applying mandatory policy. Midwives described reluctance to inform labouring women that they had a choice of fetal monitoring method. Discursive approaches used in a national fetal surveillance guideline, a Cochrane systematic review, and the largest randomised controlled trial regarding CTG monitoring in labour generated and reproduced assumptions that clinicians, not labouring women, were the appropriate decision-maker regarding fetal monitoring in labour. DISCUSSION AND CONCLUSION: Guidelines structured midwives' and obstetricians' work in a manner that undermined women's participation in decisions about fetal monitoring method. Intrapartum fetal monitoring guidelines should be critically reviewed to ensure they encourage and enable midwives and obstetricians to support women to make decisions about intrapartum care.

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http://hdl.handle.net/10453/176661