Table 1

Summary characteristics of included studies
Author/Year Aim Participants and study location Key findings reported by authors Key themes identified by reviewer
Cranston, 1980 [29] To identify the attitudes of professionals towards fetal monitoring 124 obstetric nurses; 14 hospitals, St Louis, USA 88% felt that fetal surveillance by the FM could not be achieved by IA. 90% felt that the woman was more reassured by the presence of the monitor. 59% did not feel that the FM causes more patient anxiety. 98% felt that the purpose of the FM was to improve fetal outcome. EFM is one of obstetrics best inventions. Reassurance
Safety
Technology
Anxiety
Dover and Gauge, 1995 [14] To find out how midwives carried out intrapartum FHR monitoring and what factors influenced choice of methods 117 midwives of 242 (48% response rate); 3 units, England Midwives felt confident to use IA for low-risk women; midwives would benefit from education on EFM interpretation; philosophy of childbirth affected choice of method; EFM was used when staffing levels were poor. Reassurance
Education
Monitor as midwife
Birch and Thompson, 1997 [28] To determine staff attitudes to and practice of monitoring the FHR during labour 96 professionals (14 doctors, 80 midwives, 2 unknown), (50% response rate); Consultant led unit, Wirral, England EFM has improved outcomes; overall preference for IA; disparity between midwives’ and doctors’ responses. Reassurance
Safety
Sinclair, 2001 [32] To explore how midwives used the birth technology of the CTG machine 446 midwives of 741 (60% response rate); All labour wards, Northern Ireland Dichotomy with respect to reliance on EFM and EFM as a source of anxiety; view that CTG is not required for safe birth; agreement that technology in childbirth is desirable. Reassurance
Anxiety
Technology
Walker et al, 2001 [25] To explore nurses’ attitudes towards IA 145 obstetric nurses; 5 units, South-East Michigan, USA IA should be the standard of care; staff/women ratios hinder IA use; neutral response to research on EFM and clear benefits. Education
Monitor as midwife
Munro et al, 2002 [24] To explore and respond to midwives’ views of different types of fetal monitoring in labour 20 midwives; 2 maternity units, England EFM offered reassurance; increased anxiety; EFM can hinder communication; EFM reduces mobility and increased need for pain relief; trust in technology. Reassurance
Anxiety
Communication
Technology
Altaf et al, 2006 [31] To explore midwives’ views on the experience of using EFM 20 midwives; large teaching hospital, England Feeling of reliance on EFM; EFM can erode and undermine professional skills; EFM deflecting attention from care. Reassurance
Technology
Communication
Hindley et al, 2006* [20] To explore midwives’ attitudes and experiences of intrapartum fetal monitoring 58 midwives; 2 hospitals, northern England Midwives were motivated to use EFM to protect themselves against potential litigation; EFM may provide reassurance; IA allowed for closeness to women and freedom of movement during labour; IA facilitated a more natural approach to childbirth; danger of losing skills with over-reliance on technology; EFM used when busy. Reassurance
Litigation
Communication
Technology
Monitor as midwife
Blix and Ohlund, 2007 [26] To explore what information the labour admission test is perceived to provide in the daily work of midwives 12 midwives; four maternity units, Norway The core category ‘experiencing contradictions’ was explained by three sub-categories; professional identity versus technology, feeling safe versus feeling unsafe and power versus powerlessness. Safety
Technology
McKevitt et al, 2011 [30] To examine midwives’ and doctors’ attitudes towards the use of the CTG machine in labour ward practice 29 of 56 midwives (52%) and 11 of 19 doctors (58%) (survey); 6 midwives and 2 doctors (interviews); maternity unit, Northern Ireland Questionnaires: CTGs lead to unnecessary interventions; disagreement that technology in childbirth is undesirable; agreement re use of CTG not distracting attention from mother; CTGs used unnecessarily; disagreement in always trusting the CTG and in feeling vulnerable without it; decision-making for intervention; Interviews: determining appropriate usage-CTG monitoring used to provide reassurance; reaching a decision, communication and collaboration on CTG interpretation; professional concerns-limited evidence to support CTG use, increased intervention; the way forward-more research to improve technology to monitor the fetus. Technology
Communication
Reassurance
Education
Hill, 2011 [27] To explore midwives’ views and experiences of using intermittent auscultation of the fetal heart during labour 8 midwives; large urban maternity unit, Ireland Lack of policies and guidelines on use of IA; need to provide proof of the FHR; vulnerable to litigation; culture of the organisation; medicalisation, industrialised birth and technology; walking a tightrope = dilemma of wanting to use IA, busy clinical environment and feeling vulnerable Communication
Reassurance
Litigation
Technology
Monitor as Midwife

*The results of this study are reported across three publications; references for additional papers include Hindley and Thomson [21] and Hindley & Thompson [22].

Smith et al.

Smith et al. BMC Pregnancy and Childbirth 2012 12:166   doi:10.1186/1471-2393-12-166

Open Data