A routine part of care, but not a routine informed decision

Fetal heart rate monitoring is a familiar part of care during labour. Whether maternity professionals use intermittent auscultation, continuous cardiotocography (CTG) or more invasive methods such as a fetal scalp electrode, monitoring is intended to support assessment of fetal wellbeing and inform decisions about care.

Because fetal monitoring is so embedded in everyday maternity practice, it can sometimes appear to be an automatic part of admission or labour care rather than an intervention requiring explanation, discussion and consent.

Current NICE guidelines recommend discussing fetal monitoring options during antenatal care and documenting the resulting discussions and decisions. During labour, professionals should explain why a particular method is being offered, consider the woman’s individual circumstances and preferences, and discuss how the recommended method might affect her care choices.

The Nursing and Midwifery Council Code also requires midwives to obtain informed consent before carrying out an intervention and to respect and document a person’s right to accept or decline care.

However, translating these principles into practice during labour may not always be straightforward.

• When and how should fetal monitoring options be discussed?
• What information do women need to make an informed decision?
• Is consent always explicitly sought, or is agreement sometimes assumed?
• Do professionals have sufficient time, training and resources to support these conversations

These are not simply questions about whether a consent form has been completed. They concern communication, professional responsibilities, clinical uncertainty and women’s autonomy during labour.

Understanding professional experiences

I am conducting a LJK-wide survey of maternity professionals who provide maternity care or support women in the I-JK. This may include midwives, obstetricians, doulas, advocates and people working in relevant charities or maternity organisations. This research aims to move the discussion beyond whether professionals understand the importance of consent. It asks what is needed to make meaningful consent achievable within the realities of maternity care.

The survey examines professionals’ experiences of:

• Providing information about fetal monitoring
• Discussing different monitoring options
• Seeking and documenting consent
• Supporting informed decision-making
• Responding when women decline a recommendation
• The barriers and facilitators affecting good consent practice
• The information, resources and training that could better support professionals.

Listening without blame

Discussions about fetal monitoring often focus on clinical interpretation, escalation and the prevention of avoidable harm. These remain essential elements of safe maternity care. However, safety also includes communication, autonomy, trust and ensuring that women can make an informed decision.

Maternity professionals may be trying to balance several responsibilities at once. By gathering experiences from across different roles and settings, this study seeks to identify not only barriers but also examples of approaches that work well. Understanding how professionals navigate these conversations can inform practical and realistic recommendations rather than placing responsibility solely on individual practitioners.

The survey is anonymous and takes approximately 20 minutes to complete. Have your say until the 30th November 2026: