A qualitative study of a sample of women participating in an Australian randomised controlled trial of intrapartum fetal surveillance

Abstract

Background: The STan Australian Randomised controlled Trial (START), the first of its kind in Australia, compares two techniques of intrapartum fetal surveillance (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram (STan + CTG) with CTG alone) with the aim of reducing unnecessary obstetric intervention. It is also the first comprehensive intrapartum fetal surveillance (IFS) trial worldwide, including qualitative examination of psychosocial outcomes and cost- effectiveness. In evaluating and implementing healthcare interventions, the perspectives and experiences of individuals directly receiving them is an integral part of a comprehensive assessment. Furthermore, the added value of using qualitative research alongside randomised controlled trials (RCTs) is becoming widely acknowledged. Objective: This study aimed to examine women’s experiences with the type of IFS they received in the START trial. Methods: Using a qualitative research design, a sample of thirty-two women were interviewed about their experiences with the fetal monitoring they received. Data were analysed using thematic analysis. Findings: Six themes emerged from analysis: reassurance, mobility, discomfort, perception of the fetal Scalp Electrode (FSE), and overall positive experience. Conclusion: Interestingly, it was found that women who had an FSE in the CTG alone arm of the trial reported very similar experiences to women in the STan + CTG arm of the trial. Despite STan and CTG differing clinically, from women’s perspectives, the primary difference between the two techniques was the utilisation (or not) of the FSE. Women were very accepting of STan + CTG as it was perceived and experienced as a more accurate form of monitoring than CTG alone. Findings from this study have sig- nificant implications for health professionals including midwives and obstetricians and implications for standard practice and care. The study has demonstrated the importance and significance of incorporating qualitative enquiry within RCTs.