| Description |
For the past several decades the use of routine birth interventions, such as continuous electronic fetal monitoring (cEFM) has been on the rise. Despite the increasing use of this interventions as a bio-medical model of care, 1 in 3 women gave birth via cesarean in 2011, and nearly ¼ of those operations were performed for non-reassuring fetal tracing. The rapid rise in cesarean births has shown no concomitant decrease in maternal or neonatal mortality or morbidity. Therefore, many have voiced concern over practitioner and patient's quick acceptance of cEFM as a routine part of birth, as its use has produced mixed efficacy results, and is associated with increased cesarean birth, rising healthcare costs and an over-medicalization of the natural event of childbirth. Intermittent auscultation (IA), a method of fetal surveillance that utilizes listening to the FHR at specified times at specified intervals in relation to contractions, has been deemed a safe and acceptable alternative fetal monitoring method and is recommended for low risk pregnancies. Despite this evidence, there seems to be a major lack of translation of this evidence into practice. In fact, studies have found that over 90% of women are monitored continuously throughout labor and birth. Nurses serve as the primary caregivers for patients in the intra-partum setting. Their beliefs about the normalcy or dangers of childbirth are developed through personal and professional experiences and educational background. These attitudes and inherent beliefs guide practice and care planning and can, therefore, alter patient outcomes. It has been suggested that there may be a link between nurses' personal attitudes toward childbirth, their tendency to subject mothers to unnecessary interventions, and the rising cesarean rate. Currently, the University of Utah Hospital Labor and Delivery unit provides no training to the nursing staff on the evidence or protocols for implementing IA. This study aimed to provide this important group with education regarding the evidence supporting IA, as well as optimal use, appropriate charting guidelines and examination of barriers to implementation. A pre-survey was administered to gauge current personal beliefs and knowledge gaps to implementation of IA. The evidence supporting IA was then presented via a short education session and a post-survey was then administered to analyze changes in the nurses' personal beliefs, knowledge levels and willingness to implement IA for low risk laboring women. Study results found that while nurses are willing to implement IA, they are not convinced of its superiority to cEFM, nor do they feel that it should be the standard of care for low risk women. The nurses also felt that, while low-risk women should have the right to choose their fetal monitoring method, most expect cEFM and do not routinely ask the nurse to implement IA. Many barriers were identified to implementation of IA including unclear guidelines and protocols, unwillingness of providers to order IA and high patient/nurse ratios. While some small differences were seen between pre and post surveys, education regarding IA did not change the nursing staff's beliefs regarding IA significantly. This would suggest that previous experiences and personal beliefs regarding birth interventions may make the translation of current evidence into practice difficult. |
