Effective and supportive leadership is crucial when implementing change. The successful implementation of the Listen2Baby toolkit will depend on senior multi-disciplinary leadership and commitment. This may be a big change for your organisation, and it’s really important that midwifery and obstetric senior leadership, and not just those directly involved in leading fetal monitoring, understand what’s involved and agree.

We strongly recommend that you build a case for adopting the Listen2Baby toolkit and raising the profile of IA practice, and get the support of all the senior staff listed before starting to make changes.

Excellent!

Our Listen2Baby research showed that many women who should be offered IA are instead recommended continuous EFM. Clear, visible criteria support midwives to offer IA to women who should not be recommended EFM. These need to be checked and updated regularly as guidance changes. It is important that these criteria are not just clear and accessible to midwives in midwifery-led settings, but also in triage and on delivery suite so that midwives are supported to offer recommended care to women in all settings.

Our Listen2Baby research showed that many women who should be offered IA are instead recommended continuous EFM. Clear, visible criteria support midwives to offer IA to women who should not be recommended EFM. These criteria need to be checked and updated regularly as guidance changes. It is important that these criteria are not just clear and accessible to midwives in midwifery-led settings, but also in triage and on delivery suite so that midwives are supported to offer recommended care to women in all settings.

Brilliant!

It’s important to know how many women are having IA, because these data can help you monitor your progress in supporting IA practice using the Listen2Baby toolkit, and may be helpful to make the case for additional staffing.
Our Listen2Baby research showed that when units had data about who had IA, this helped identify where more support for the offer of IA might be needed.
al staffing.

It’s important to know how many women are having IA, because these data can help you monitor your progress in supporting IA practice using the Listen2Baby toolkit, and may be helpful to make the case for additional staffing.
Our Listen2Baby research showed that when units had data about who had IA, this helped identify where more support for the offer of IA might be needed.

Great!

Women need evidence-based information about their options to make an informed choice about fetal monitoring during labour.
In Listen2Baby we found that women often lacked information about fetal monitoring. Some were unaware of their options, and could not recall any discussion about fetal monitoring before or during their labour, or did not know they could discuss these with their care provider. Some women reported being put on continuous EFM without any discussion about reasons why or their options.

That’s a good start.

Women need evidence-based information about their options to make an informed choice about fetal monitoring during labour.
In Listen2Baby we found that women often lacked information about fetal monitoring. Some were unaware of their options, and could not recall any discussion about fetal monitoring before or during their labour, or did not know they could discuss these with their care provider. Some women reported being put on continuous EFM without any discussion about reasons why or their options.

Women need evidence-based information about their options to make an informed choice about fetal monitoring during labour.
In Listen2Baby we found that women often lacked information about fetal monitoring. Some were unaware of their options, and could not recall any discussion about fetal monitoring before or during their labour, or did not know they could discuss these with their care provider. Some women reported being put on continuous EFM without any discussion about reasons why or their options.

Brilliant!

This is an important factor in IA being valued as a skill, but it’s also about safety. It is important for midwives and medical staff to train together to understand the value of IA and how to interpret IA findings. This can save valuable time decision-making if a woman is transferred from IA to CTG monitoring with a FHR concern.
In Listen2Baby we found that some midwives don’t feel confident in the skills required to practice IA, and that both midwives and obstetricians often regarded IA skills as less important compared with CTG skills. Together these issues can result in IA being practiced less often, eroding IA skills still further.
We observed that when obstetricians trained alongside midwives in IA, this helped increase the profile and perceived value of IA skills, promote shared confidence in IA to detect fetal heart concerns, leading to better co-ordination of labour management during transfer.

This is an important factor in IA being valued as a skill, but it’s also about safety. It is important for midwives and medical staff to train together to understand the value of IA and how to interpret IA findings. This can save valuable time decision-making if a woman is transferred from IA to CTG monitoring with a FHR concern.
In Listen2Baby we found that some midwives don’t feel confident in the skills required to practice IA, and that both midwives and obstetricians often regarded IA skills as less important compared with CTG skills. Together these issues can result in IA being practiced less often, eroding IA skills still further.
We observed that when obstetricians trained alongside midwives in IA, this helped increase the profile and perceived value of IA skills, promote shared confidence in IA to detect fetal heart concerns, leading to better co-ordination of labour management during transfer.

Fantastic!

An understanding of fetal physiology is necessary, and underpins confident interpretation and practice of IA.
In Listen2Baby, in settings where IA interpretation was underpinned by training in fetal physiology, midwives were more confident in their IA skills and there was a shared confidence in IA to detect fetal heart concerns.

An understanding of fetal physiology is necessary, and underpins confident interpretation and practice of IA.
In Listen2Baby, in settings where IA interpretation was underpinned by training in fetal physiology, midwives were more confident in their IA skills and there was a shared confidence in IA to detect fetal heart concerns.

Excellent!

Regular opportunity to discuss and reflect on IA practice with colleagues helps build a supportive environment that understands and promotes the practice of IA. Regular opportunity to reflect on practice is recognised as important for continuous leaning, to improve practice, safety, quality of care, and retention.
In Listen2Baby, in settings where IA cases were regularly discussed, both midwives and obstetricians valued IA skills on a par with CTG skills. This helped support midwifery confidence in their skills and meant that more women were offered the option of IA monitoring.

Regular opportunity to discuss and reflect on IA practice with colleagues helps build a supportive environment that understands and promotes the practice of IA. Regular opportunity to reflect on practice is recognised as important for continuous leaning, to improve practice, safety, quality of care, and retention.
In Listen2Baby, in settings where IA cases were regularly discussed, both midwives and obstetricians valued IA skills on a par with CTG skills. This helped support midwifery confidence in their skills and meant that more women were offered the option of IA monitoring.

Regular opportunity to discuss and reflect on IA practice with colleagues helps build a supportive environment that understands and promotes the practice of IA. Regular opportunity to reflect on practice is recognised as important for continuous leaning, to improve practice, safety, quality of care, and retention.
Regular opportunity to discuss and reflect on IA practice with colleagues helps build a supportive environment that understands and promotes the practice of IA.
In Listen2Baby, in settings where IA cases were regularly discussed, both midwives and obstetricians valued IA skills on a par with CTG skills. This helped support midwifery confidence in their skills and meant that more women were offered the option of IA monitoring.

Amazing!
Supportive mentorship can ensure safety, competence and confidence in IA practice. If midwives do not have the opportunity to develop or maintain their skills in IA monitoring, this can lead to a lack of confidence, but also has implications for safety and quality of care.
In Listen2Baby, in some settings midwives who needed or asked for extra IA practice support (e.g. were newly qualified, or rotating onto the MLU from delivery suite) were supported on shift by an experienced MW who would listen-in together with the midwife and discuss fetal heart interpretation and labour management. This helped confirm their IA skills and develop their confidence.

Supportive mentorship can ensure safety, competence and confidence in IA practice. If midwives do not have the opportunity to develop or maintain their skills in IA monitoring, this can lead to a lack of confidence, but also has implications for safety and quality of care.
In Listen2Baby, in some settings midwives who needed or asked for extra IA practice support (e.g. were newly qualified, or rotating onto the MLU from delivery suite) were supported on shift by an experienced MW who would listen-in together with the midwife and discuss fetal heart interpretation and labour management. This helped confirm their IA skills and develop their confidence.

Great!
Element 4 of the Saving Babies Lives Care Bundle says that an ‘objective holistic review’ by a colleague should be undertaken at least four-hourly when IA is being used. This is in addition to a holistic review of maternal and fetal wellbeing (for which there is no requirement to involve a colleague).
In Listen2Baby, in the settings providing best support for IA practice, midwives looking after women in labour and using IA received frequent support from a colleague who checked in on midwifery wellbeing in addition to reviewing maternal and fetal wellbeing.

Element 4 of the Saving Babies Lives Care Bundle says that an ‘objective holistic review’ by a colleague should be undertaken at least four hourly when IA is being used. This is in addition to a holistic review of maternal and fetal wellbeing (for which there is no requirement to involve a colleague).
In Listen2Baby, in the settings providing best support for IA practice, midwives looking after women in labour and using IA received frequent support from a colleague who checked in on midwifery wellbeing in addition to reviewing maternal and fetal wellbeing.

Fantastic!

During spontaneous vaginal births there are many competing demands on midwives’ time.
In Listen2Baby, we observed that when a single midwife was present at a spontaneous vaginal birth, care was often required to be compromised as it was not possible to undertake all procedures required as a single person. When a second midwife was present, this facilitated contemporaneous documentation and procedural support, allowing the primary midwife to support the woman and monitor the wellbeing of the baby.
The Oneplus trial found the presence of two midwives during the active second stage of labour in nulliparous women and the birth of the baby reduced the incident rate of severe perineal trauma by 30%, and was positively received by women .
We recommend units actively support the practice of having a that a second midwife be present at all spontaneous vaginal births, providing support for at least 15-30 minutes prior to birth for nulliparous women.
We further recommend units have a staffing model that supports the availability of a second midwife throughout the second stage of labour.

During spontaneous vaginal births there are many competing demands on midwives’ time.
In Listen2Baby, we observed that when a single midwife was present at a spontaneous vaginal birth, care was often required to be compromised as it was not possible to undertake all procedures required as a single person. When a second midwife was present, this facilitated contemporaneous documentation and procedural support, allowing the primary midwife to support the woman and monitor the wellbeing of the baby.
The Oneplus trial found the presence of two midwives during the active second stage of labour in nulliparous women and the birth of the baby reduced the incident rate of severe perineal trauma by 30%, and was positively received by women.
We recommend units actively support the practice of having a second midwife present at all spontaneous vaginal births, providing support for at least 15-30 minutes prior to birth for nulliparous women.
We further recommend units have a staffing model that supports the availability of a second midwife throughout the second stage of labour.

Fantastic!

During the second stage of labour there are many competing demands on midwives’ time.
In Listen2Baby, we observed that when a second midwife was present during the second stage of labour, this provided optimal support for the woman and for the practice of IA according to guidance.
The Oneplus trial found the presence of two midwives during the active second stage of labour in nulliparous women and the birth of the baby reduced the incident rate of severe perineal trauma by 30%, and was positively received by women.
We recommend units actively support the practice of having a second midwife be present at all spontaneous vaginal births, providing support for at least 15-30 minutes prior to birth for nulliparous women. We further recommend units have a staffing model that availability of a second midwife during the second stage of labour.

During the second stage of labour there are many competing demands on midwives’ time.
In Listen2Baby, we observed that when a second midwife was present during the second stage of labour this provided optimal support for the woman and for the practice of IA according to guidance.
The Oneplus trial found the presence of two midwives during the active second stage of labour in nulliparous women and the birth of the baby reduced the incident rate of severe perineal trauma by 30%, and was positively received by women.
We recommend units actively support the practice of having a second midwife present at all spontaneous vaginal births, providing support for at least 15-30 minutes prior to birth for nulliparous women.
We further recommend units have a staffing model that supports the availability of a second midwife during the second stage of labour.

Great!

Having a range of IA equipment available, including Dopplers with number displays, and encouraging midwives to use the equipment that they feel most confident with, supports IA practice. There is no evidence that one type of Doppler is any better than another.
In Listen2Baby we found that in settings where midwives were confident in their IA practice they were supported to use the device that they felt most comfortable with.
Understanding whether equipment issues are a key driver of your unit’s IA practice can also help you to make the case for improved management of equipment.

Having a range of IA equipment available, including Dopplers with number displays, and encouraging midwives to use the equipment that they feel most confident with, supports IA practice. There is no evidence that one type of Doppler is any better than another.
In Listen2Baby we found that in settings where midwives were confident in their IA practice they were supported to use the device that they felt most confident using.
Understanding whether equipment issues are a key driver of your unit’s IA practice can also help you to make the case for improved management of equipment.

Brilliant!

If devices such as Dopplers, including those with number displays, analogue clocks, lights and equipment stands are not readily available, well maintained and reliable, it can undermine practitioners’ confidence to use them for IA – it can feel easier to place a CTG monitor on the labouring woman.

If devices such as Dopplers, including those with number displays, analogue clocks, lights and equipment stands are not readily available, well maintained and reliable, it can undermine practitioners’ confidence to use them for IA – it can feel easier to place a CTG monitor on the labouring woman.

Excellent!

Guidance recommends contemporaneous documentation of the FHR every 15 minutes in the first stage of labour and every 5 minutes in second stage. This is not easy as there are many other activities involved with caring for the woman and her family in labour.
In our Listen2Baby research, we observed a number of factors that supported contemporaneous documentation of the FHR. These included: the presence of a second midwife in the second stage of labour; setting computers/tablets so they don’t log out between FH readings; having portable digital devices; and recording the FH in one place on the partogram.

Guidance recommends contemporaneous documentation of the FHR every 15 minutes in first stage of labour and every 5 minutes in second stage. This is not easy as there are many other activities involved with caring for the woman and her family in labour.
In our Listen2Baby research, we observed a number of factors that supported contemporaneous documentation of the FHR. These included: the presence of a second midwife in the second stage of labour; setting computers/tablets so they don’t log out between FH readings; having portable digital devices; and recording the FH in one place on the partogram.