Intersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspective.

Abstract

Background: Intrapartum Electronic Fetal Monitoring interpretation is subjective, variable and dependent on clinical expertise. Electronic Fetal Monitoring is also influenced by human factors, such as the labour ward context, staffing pressures, situational awareness, local protocols, workflow variations, team dynamics, and reporting cultures. This paper explored whether, and how, socio-technical factors may have the potential to contribute to disparities in intrapartum Electronic Fetal Monitoring care and their implications for maternal and neonatal health.

Methods: This study employed an exploratory qualitative design to investigate clinicians' experiences of Electronic Fetal Monitoring. Eighteen semi-structured interviews were undertaken online with midwives, student midwives and obstetricians involved in labour ward care in the UK. Critical Race Feminism and Intersectionality theories shaped the study design and analysis. Interviews were analysed using reflexive thematic analysis.

Results: Seven themes were identified under the overarching theme intersectional dynamics in intrapartum Electronic Fetal Monitoring: 1) Social determinants in Electronic Fetal Monitoring interpretation, (2) Disparities in care expectations and decision agency, (3) Cultural influence on decision choices, (4) Disparities in communication, (5) Rationalising Electronic Fetal Monitoring outcomes towards preferred course of action, (6) Stereotypes and bias, and (7) Wider influences of Electronic Fetal Monitoring and labour care.

Conclusions: Electronic Fetal Monitoring is a socially and contextually interpreted tool used to support particular interventions or inactions. Electronic Fetal Monitoring management is subject to systematic contextual influences, maternal Social Determinants of Health and biases that may further contribute to disparities in labour care and outcomes. Addressing maternal Social Determinants of Health while providing Electronic Fetal Monitoring care is vital to promoting equitable care, facilitating a positive experience and improving health outcomes.