Title Understanding Intelligent Intermittent Auscultation

Abstract

ORCID id Monitoring the fetal heart rate via intermittent auscultation (IA) during labour is a core midwifery skill and component of clinical practice. While it is not a diagnostic tool, i.e. it cannot predict future outcomes, it does guide clinical care and decision-making regarding the risk of fetal hypoxia.1 Fundamental to good IA is the understanding of fetal physiology, its changes throughout labour and signs of potential deterioration, and escalation if necessary.1 As such, IA requires skill to carry out; including abdominal palpation skills and competence in the use of Pinard stethoscopes and Doppler equipment. However, assessing the fetal heart is just one element of understanding fetal wellbeing during labour and birth; the skill involved also requires interpretation in light of the whole picture. Therefore, the mother-baby dyad together needs to be considered simultaneously i.e. maternal wellbeing, phase of labour, maternal position etc. IA for healthy women at low risk of complications should be the default method to assess fetal wellbeing.2 However, in recent years, an over-reliance on cardiotocography (CTG) may have contributed to a decline in midwives’ competence and confidence using IA.2 Moreover, international variations of how to carry out IA has created further implementation challenges.2