Consensus Guidelines for Intermittent Auscultation in United States Community Birth Settings.

Abstract

Background: Intermittent auscultation is the gold standard for fetal assessment in uncomplicated pregnancies and labors and is used universally in the community birth setting. Great variation exists in intermittent auscultation practices and language used by community birth midwives across the country. Current standards, as defined by midwifery schools, state midwifery licensing boards, and individual midwifery practices, differ significantly and sometimes contradict each other. Community birth midwives, nurses and birth assistants, midwifery educators and those working in community birth quality improvement have been in need of common language and guidance on best practices in intermittent auscultation.

Objective: Develop and disseminate consensus standards for intermittent auscultation in the community birth setting in the United States.

Methodology: Creation of guidelines through a 21-month consensus process with a workgroup of educators, leaders, quality improvement experts, and practicing midwives by identifying practices supported by evidence or clinical experience, evaluating current evidence and guidelines, eliciting feedback from education, midwifery, nursing, and birth center organizations, and incorporating revisions to create the final document.

Results: Consensus was reached on various elements of intermittent auscultation and guidelines were created. These guidelines address readiness, assessment, interpretation, and documentation of fetal heart tones, clinical decision making, and areas for future research. These guidelines provide a minimum standard for performance and documentation of intermittent auscultation in community birth midwifery practice.