Why is this important?

Intermittent auscultation (IA) is the main way of assessing the baby’s wellbeing during labour, used by midwives in women who are healthy with straightforward pregnancies. 

• For women at low risk of complications, IA is recommended.
  • Compared with CTG monitoring, women monitored with IA have a lower risk of intervention during labour and birth, and it’s safe, with no difference in terms of outcomes for the baby.
• MNSI, MBRRACE-UK, the ESMiE enquiry and Each Baby Counts have all identified problems with IA not being carried out in line with guidance, leading to death or severe injury in babies.
  • IA not always carried out at the right time, for long enough or often enough
  • IA and FHR are not always recorded properly in women’s notes
  • All enquiries have recommended improved IA training and/or audit

Before Listen2Baby there was no research evidence to help us understand how best to support midwives to practice IA in the best way. 

• The Listen2Baby research identified the key issues that underlie problems with IA practice:
  • A lack of ‘visibility’ of IA as a skill;
  • A lack of shared understanding of IA skills and benefits, which are undervalued compared with CTG skills;
  • Not all midwives are confident in their IA skills and the offer of IA;
  • Women are not always aware of fetal monitoring options;
  • Relatively low numbers of women are being offered IA and, as a result, there is less opportunity for midwives to develop and maintain their IA skills;
  • A staffing and practice environment, particularly in the second stage of labour, that is not always supportive for midwives to practise IA in line with guidance or to document the FHR contemporaneously;
  • A lack of choice and availability of equipment (including Pinards, Doppler devices with FHR displays, and clocks with second hands) to support midwives to use the device they feel most confident using.
• In combination, these factors mean that not all women who should be offered IA monitoring during labour are getting it, and that the IA monitoring that is provided does not always meet national guidance.
• The Listen2Baby Toolkit can help address these issues.

Download a printable summary of the Listen2Baby Toolkit and why you should use it