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

PROBLEM: 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. BACKGROUND: 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. AIM: 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. METHODS: 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. FINDINGS: Three themes were identified; Optimising the experience for larger bodied women; Time pressures and troubleshooting; and, Excited for change. DISCUSSION: 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. CONCLUSION: 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.