A grounded theory study of midwives' decision-making: Use of continuous electronic foetal monitoring on low risk labouring women

Many midwives continue to use Continuous Electronic Foetal Monitoring (CEFM) on low risk women in labour, despite overwhelming clinical evidence that it is unnecessary. The use of CEFM on low risk labouring women has been linked to rising rates of medical intervention during labour and birth with no improvement in long term neonatal outcomes. This study examined the decision-making processes of midwives who used CEFM on low risk labouring women. Whilst a number of previous studies have examined various aspects of CEFM, none specific to midwives' decision-making and CEFM on low risk labouring women. This study contributes to the literature in this specific area. The theoretical origins of Symbolic Interactionism and Grounded Theory (GT) methods underpin this study. SI, a sociological theory that emphasises meaning in human interactions and behaviours is used in this study to focus on the behaviours and interactions of five midwives'when deciding to use CEFM on low risk labouring women. Primary data were collected by conducting unstructured interviews and systematic analysis was undertaken using GT methods to generate a substantive theory of: Midwives' CEFM decision-making despite evidence based guidelines. The midwives made the decision that led to CEFM at two key points in the woman's labour care. Firstly, during the initial assessment of the woman and foetus, some midwives decided to use a baseline CTG rather than intermittent auscultation (IA). Secondly, following initial assessment, the midwives made an individualised assessment and decided whether to use CEFM as the method to monitor the foetus during labour. Trust was identified as the core variable, having a profound effect on the midwives' decision-making at these two points. Another significant factor that impacted on decision-making was staff workload.;Recommendations relating to these findings promote that labouring women be central and intimately involved in decisions about foetal monitoring. Workplace reforms, such as the introduction of midwifery led models of care for women within a community setting are recommended to address professional trust and workload issues. Through the implementation of these recommendations it is expected that midwives will embrace the notion of woman centred care and that the unnecessary use of CEFM on low risk labouring women will be reduced.