Journal article
Facilitators and barriers to the practice of intermittent auscultation fetal monitoring in UK maternity services: a qualitative study using the consolidated framework for implementation research (CFIR)
- Abstract:
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Objectives: To explore barrier and facilitators to midwifery practice of intermittent auscultation according to national guidance in the UK.
Design: Multisite ethnographic study using observations of practice, semi-structured interviews and informal conversations. Framework analysis using the Consolidated Framework for Implementation Research (CFIR).
Setting: Eleven maternity units across seven NHS maternity services in England and Wales in 2024.
Participants: Midwives and other maternity care professionals involved in fetal monitoring during labour.
Intervention: ‘Intermittent auscultation’ (IA), or listening to the fetal heart rate at regular intervals, to monitor fetal wellbeing during active labour.
Outcome measures: Not applicable.
Results: IA monitoring was frequently observed to be marginalised due to national and local pressures. IA is a complex skill that requires expertise and practice to develop and maintain. However, lack of a robust evidence base for IA methods is a further barrier to implementation. The study uncovered examples of facilitators that include: leadership engagement, access to knowledge and information supported in mentorship programmes and peer support models. These features created micro-environments where IA was valued, supported and integrated into care.
Conclusions: Our study highlights the significant impact of multi-level factors on the implementation of IA within UK maternity care. However, when organisational readiness, strong leadership engagement, and supportive conditions are present, IA can be delivered in accordance with guidance. These findings underscore the need to align policy, infrastructure, and organisational culture to sustain evidence-based, woman-centred practices such as IA.
Strengths and Limitations:
• The ethnographic approach provides unique insights into the how and why of IA implementation.
• Analysis using an implementation framework provides clear direction of where to target resources for implementation support.
• A sample size of 11 maternity units may impact transferability of findings.
• Data was collected by one researcher, however perspectives of the whole research team were incorporated through a group analysis approach, strengthening the trustworthiness of the analysis.
• There were limited opportunities to observe midwives using IA in labour due to low numbers of women experiencing IA in their labour during the observation period.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 320.6KB, Terms of use)
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- Publisher copy:
- 10.1136/bmjopen-2025-115855
Authors
- Publisher:
- BMJ Publishing Group
- Journal:
- BMJ Open More from this journal
- Volume:
- 16
- Issue:
- 4
- Article number:
- e115855
- Publication date:
- 2026-04-24
- Acceptance date:
- 2026-04-01
- DOI:
- EISSN:
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2044-6055
- ISSN:
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2044-6055
- Language:
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English
- Pubs id:
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2398329
- Local pid:
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pubs:2398329
- Deposit date:
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2026-04-01
- ARK identifier:
Terms of use
- Copyright holder:
- MacLellan et al.
- Copyright date:
- 2026
- Rights statement:
- © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
- Licence:
- CC Attribution (CC BY)
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