Email updates

Keep up to date with the latest news and content from BMC Pregnancy and Childbirth and BioMed Central.

Open Access Research article

Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women

Robyn M Maude1*, Joan P Skinner1 and Maralyn J Foureur2

Author Affiliations

1 Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Newtown, PO Box 7625, Wellington, New Zealand

2 Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney, Australia

For all author emails, please log on.

BMC Pregnancy and Childbirth 2014, 14:184  doi:10.1186/1471-2393-14-184

Published: 31 May 2014



Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings.


A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session.


Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60 ā€“ 0.95, pā€‰=ā€‰0.016).


The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women.

Intermittent auscultation; Fetal heart rate monitoring; Decision-making; Clinical; Knowledge translation; Mixed methods