Who is offered IA

Intermittent monitoring is recommended by NICE for women and babies at low risk of complications, both on admission and during labour. Offering the option of IA monitoring supports women’s choice, but it is also about quality and safety of care. Compared with continuous electronic fetal monitoring (EFM), IA is associated with less intervention and no difference in outcomes for babies. IA monitoring enables the woman to move freely in labour and to adopt the positions she finds most helpful, and can also be used in a birth pool. 

In Listen2Baby, we observed that not all women who were eligible for IA monitoring were offered it. This happened because staff were not aware of who should be offered IA, but also because staff were not sufficiently confident in the value of IA and/or their IA skills. 
With relatively low numbers of women being monitored in labour using IA there is less opportunity for staff to develop and maintain IA skills and confidences. This further impacts women and the quality and safety of care.

We also saw examples of good practice. In one site, women who had experienced an uncomplicated pregnancy, and attended triage with spontaneous rupture of membranes, were routinely directed to the birth centre and offered IA monitoring as one of their options. In another site, obstetricians questioned the appropriateness of EFM in women with an uncomplicated pregnancy.

It is important that the MDT team agree on clear local eligibility criteria based on NICE guidance. It should be visible and understood across the MDT team working in triage, the MLU and delivery suite so that women are offered choice in their monitoring options.

Review of these criteria and the offer of IA to women, in fetal monitoring training sessions or weekly educational meetings, can be used to clarify understanding among staff, and offer choice to women.

Consider collecting data to inform your planning.