Scope for improved intermittent auscultation (IA) regime mitigating serious systemic risks, for wider acceptance in American, British and International Practice

Cases of serious birth asphyxia continue to occur following suboptimal and apparently well-conducted Intermittent Auscultation (IA) raising questions of accuracy and reliability. Systematic-reviews have provided questions but hardly any answers. This analytical review suggests improvements in safety and practicality of IA using advances in technology and accumulation of observational evidence in clinical cases including knowledge from cardiotocography. The terminology ‘Auscultation’ can translate to a mistaken ideological commitment to ‘actual/manual counting’ of audible fetal heart rate (FHR) tones. This routine practice should be questioned/reconsidered when the modern hand-held Doppler devices continuously display a concurrent accurate FHR, not possible by counting. Furthermore, actual case studies show that the FHR abnormalities could be misinterpreted with a single-count or may extend beyond one minute. A reanalysis of the investigation by the ‘National Health Service (NHS) Resolution’ in UK shows that it was unfair to hold midwives primarily responsible for adverse outcomes because of not rigidly following the IA regime by the National Institute for Health and Care Excellence (NICE, UK). The serious pitfalls associated with the single-count methodology of NICE and similar IA regimes seem to predispose midwives to systemic errors with continuing risk to babies. In contrast, the American College of Nurse-Midwives proposes a better multiple-count method. The British midwives have not adopted similar multiple-count method finding it cumbersome in first stage and impossible (every five minutes) in the second stage. This article enables midwives to compare the safety of different IA regimes including the recent ‘Advanced Intermittent Auscultation (AIA)’ which does away with manual counting. The AIA also opens an additional possibility for Nurse-Midwives to make a fair judgement of the baseline variability of FHR (although non-mandatory), addressing a concern by some clinicians with IA. Nurse-Midwives have a crucial role in selecting a safer more efficient IA enabling more choice for women.