What question did this study set out to answer?

This survey aimed to evaluate the utilization and teaching of cardiotocography (CTG) and the confidence levels of midwives and obstetricians in Germany.

June 5, 2026Open Access

Training and Subjective Confidence in CTG Interpretation in Germany: A National Cross-Sectional Survey

Key Points

This survey aimed to evaluate the utilization and teaching of cardiotocography (CTG) and the confidence levels of midwives and obstetricians in Germany.
National cross-sectional online survey conducted among midwives, obstetricians, and trainees in Germany.
Questionnaire assessed workplace characteristics, CTG education, usage of classification systems, and self-rated confidence on a scale of 0-100.
Descriptive analyses were performed on the responses of 1,132 participants.
95.5% of respondents reported routinely using CTG, with 85.3% identifying the FIGO classification system as the most common.
79.7% of midwives received CTG education during training, compared to only 9.5% of junior doctors.
Over half of junior doctors and 39.4% of specialists had not attended CTG training in the last five years; most participants reported moderate confidence in CTG interpretation.

Abstract

Purpose: Cardiotocography (CTG) is widely used for intrapartum fetal surveillance, but interpretation remains heterogeneous and prone to interobserver variation. This study explored which CTG classification systems are used in German maternity care, how CTG interpretation is taught, and how confident midwives and obstetricians feel when interpreting CTG traces and fetal scalp blood sampling results. Patients and Methods: We conducted a national pilot exploratory online cross-sectional survey among midwives, obstetricians, and trainees in Germany. The questionnaire covered workplace characteristics, professional experience, CTG education, onboarding, current use of CTG classification systems, and self-rated confidence using an intuitive 0– 100 scale. The survey was developed by the research team for this exploratory project and was not formally validated or pilot tested. Analyses were descriptive only. Results: A total of 1,132 respondents completed the questionnaire, including 60.4% midwives, 30.5% obstetricians, and 9.6% students. CTG was routinely used by 95.5% of respondents, and FIGO was the most commonly reported classification system (85.3%). CTG education during formal professional training was reported by 79.7% of midwives but by only 9.5% of junior doctors. Among physicians, CTG knowledge was commonly acquired from colleagues or through workplace experience. Only 39.7% of junior doctors reported systematic onboarding in the delivery room. More than half of junior doctors and 39.4% of specialists had not attended CTG training in the previous five years. Across professional groups, respondents reported only moderate confidence in CTG interpretation. Nearly all participants (99%) expressed a need for structured CTG training in Germany. Conclusion: This exploratory survey suggests considerable variation in CTG education, onboarding, and self-reported confidence among maternity care professionals in Germany. The findings support the need for more structured and recurring CTG education, while underscoring that the present data reflect subjective perceptions rather than objective competence or clinical outcomes. Keywords: cardiotocography, CTG training, fetal monitoring, subjective confidence, survey, Germany

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