"When it works well, it's great!": Midwives perspectives on the beltless non-invasive fetal electrocardiogram for women in larger bodies in labour.

Higher body weight is linked to an increased risk of certain perinatal complications, hence continuous electronic fetal monitoring in labour is often recommended. Most available devices constrain midwives' ability to optimise women's physiological processes. Options for fetal monitoring in labour fo...

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Published in:Women & Birth Vol. 39; no. 1
Main Authors: Hawke, Madeline, Baird, Kathleen, Scarf, Vanessa, Pickup, Elizabeth, Fox, Deborah
Format: research Journal Article
Published: Elsevier B.V. Feb2026
Online Access:View this record in EBSCOhost
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      dt: Feb2026
      vid: 39
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      pub: Elsevier B.V.
      place: New York, New York
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        191349452
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        191349452
        10.1016/j.wombi.2025.102150
        191349452
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        atl: "When it works well, it's great!": Midwives perspectives on the beltless non-invasive fetal electrocardiogram for women in larger bodies in labour.
      aug:
        au:
          Hawke, Madeline
          Baird, Kathleen
          Scarf, Vanessa
          Pickup, Elizabeth
          Fox, Deborah
        affil: Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
      sug:
        subj:
          Midwifery Psychosocial Factors
          Fetal Monitoring
          Labor
          Obesity, Maternal
          Monitoring, Physiologic
          Midwife Attitudes
          Human
          Female
          Attitude of Health Personnel
          Equipment Design
          Signal Processing, Computer Assisted
          Uterine Contraction Physiology
          Body Weight
          Body Mass Index
          Workflow
          Diffusion of Innovation
          Focus Groups
          Implementation Science
          Interviews
          Thematic Analysis
          Australia
          Hospitals
          Female
      ab: Higher body weight is linked to an increased risk of certain perinatal complications, hence continuous electronic fetal monitoring in labour is often recommended. Most available devices constrain midwives' ability to optimise women's physiological processes. Options for fetal monitoring in labour for women in larger bodies are limited. Evidence demonstrates non-invasive fetal electrocardiography monitors fetal wellbeing more effectively than cardiotocogram. Literature about midwives' experiences of fetal monitoring when caring for women in larger bodies is limited. To understand the views and experiences of midwives using the beltless non-invasive fetal electrocardiogram when caring for women with BMI≥ 35 kg/m² in labour. Findings are derived from a clinical trial that included an implementation study. This article reports on the thematic analysis of focus group and interview data from eighteen midwives (M1–18) across three hospital sites in Australia. Three themes were identified; Optimising the experience for larger bodied women ; Time pressures and troubleshooting ; and, Excited for change. The beltless design of the non-invasive fetal electrocardiogram was welcomed. Adoption was hampered by challenges related to consistency in fetal heart rate signals. Uterine contraction measurement was perceived as superior to traditional options. Midwives are motivated to support women in larger bodies to have positive birth experiences, and they accept that maturing new technologies takes time. While the non-invasive fetal electrocardiogram does not yet fulfil the need for certainty in fetal heart rate connection, midwives responded positively to its beltless design and the reliability of uterine contraction measurement.
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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