The Mid-Tech survey: Midwives’ views about the influence of intrapartum fetal surveillance technologies upon supporting women’s bodily autonomy

BACKGROUND: Bodily autonomy is central to respectful, woman centred care. Midwives must facilitate informed decision-making, including choices about intrapartum fetal surveillance, and uphold women's instinctive movement and positioning. AIM: To explore midwives' perceptions of how different intrapartum fetal surveillance technologies affect their ability to support bodily autonomy. METHODS: The 2024 Mid-Tech survey was completed online by 396 Australian midwives. Descriptive statistics summarised responses. Adjusted logistic regression analyses examined associations between technology access and: (1) use of intermittent auscultation, and (2) perceptions of woman centred care when using continuous electronic fetal monitoring. RESULTS: Wired cardiotocography was perceived as most restrictive to mobility, followed by wireless telemetry. Fetal scalp electrodes and beltless patches were perceived as less restrictive; handheld dopplers, the least. One in four midwives reported inconsistent access to intermittent auscultation equipment (e.g., handheld doppler), only 64.6 % had adequate access to wireless continuous electronic fetal monitoring technologies. Intermittent auscultation use was low but higher among midwives with consistent equipment access (OR:3.84;95 % CI:2.21-6.68;p < 0.001), and with adequate pre-registration (OR: 2.25;95 % CI:1.30-3.89;p < 0.01) and post-registration training (OR:2.26;95 % CI:1.45-3.50;p < 0.001). Less than 15 % of midwives believed that women being continuously monitored received woman centred care, this was more likely when access to wireless continuous electronic fetal monitoring technologies were adequate (OR:2.96;95 % CI:1.42-6.15;p < 0.01). CONCLUSION: Consistent access to wireless continuous electronic fetal monitoring supports midwives in upholding bodily autonomy. Improving access to and education in intermittent auscultation may increase its use. Given less restrictive alternatives, wired cardiotocography devices may no longer be fit for purpose.