Why obstetricians should support intermittent auscultation
Intermittent auscultation (IA) is a vital clinical skill used to assess fetal wellbeing during labour in women who are healthy with straightforward pregnancies. It involves listening to the fetal heart rate at regular intervals using a Pinard stethoscope or hand-held Doppler. IA is recommended by NICE and supports safer, less medicalised births.
Why do obstetricians need to know about IA?
Midwives typically perform IA, but it is essential that obstetricians also understand its importance, interpretation, and implementation to ensure safe, evidence-based maternity care across the entire labour and birth pathway. In Listen2Baby, best IA practice was seen in settings where:
- there was multi-disciplinary support for IA skills;
- obstetricians and midwives trained in IA together.
Why IA matters
Fewer clinical interventions, including lower rates of caesarean and instrumental births, compared with CTG, for women at low risk of complications [NICE CG190].
No increase in adverse neonatal outcomes compared with CTG, for women at low risk of complications.
Enhanced maternal experience, allowing more mobility and a less medicalised environment during labour.
The role of obstetricians
Obstetricians play a critical role in setting standards for safe practice and interpreting findings when midwives escalate concerns.
A robust understanding of IA helps clinicians:
- Identify when a pregnancy becomes higher-risk and requires escalation.
- Make informed decisions when concerns are raised.
- Support multidisciplinary training and standards across maternity teams.
Building a culture of safe monitoring
Obstetricians can lead the way by:
- Embedding IA into staff training;
- Promoting shared understanding across teams;
- Ensuring supportive environments and adequate staffing;
- Improving documentation and escalation processes.
IA is more than a technique - it’s a safeguard. When used correctly, it supports physiological labour, reduces unnecessary intervention, and helps detect early signs of fetal distress.
This study is funded by the National Institute for Health and Care Research (NIHR)