Trace display Doppler monitors

Intrapartum fetal monitoring is going through a period of intense scrutiny in the UK. Midwives are on the front line of cardiotocography (CTG) interpretation and intermittent auscultation (IA) of fetal heart rate (FHR) during labour. A consultation on a ‘draft addendum’ for exceptional review of the National Institute for Health and Care Excellence (NICE, 2014) guidelines regarding intrapartum fetal monitoring closed on 25 November 2016. One of the questions posed for consultation was: for how long and when should the fetal heart be auscultated? For example, one minute during or immediately after a contraction or between contractions? It was important for midwives to express their views on this question—as individuals or through their representatives—in the registered stakeholder institutions, especially because British obstetricians in general have little training, experience or interest in IA, and do not practise it. Moreover, there is more to discuss concerning IA with the availability of new handheld Doppler FHR monitors, which provide numerical readouts as well as ‘FHR trace display’ during the auscultation period (e.g. the Huntleigh Sonicaid SR2 digital Doppler). These intermittently-recorded FHR traces could be replayed during labour and downloaded onto computers to be archived in a patient's electronic record. Further amendments to guidelines could be an opportunity to comment on the place of additional functionality in midwifery practice of IA, especially regarding accountability and medico-legal implications. Some maternity units in the UK have already purchased these more advanced Doppler monitors because they are only slightly more expensive but provide an extra dimension of functionality. Moreover, the older Doppler monitors may be eventually phased out. Most maternity units use the new monitors to simply read numerical displays of FHR across 1 minute (after contractions), which are then documented in clinical notes without viewing or archiving of the intermittent FHR traces. This article critically analyses the possible role of the latest Doppler monitors in IA, especially in the context of current guidelines and any future addenda.