Towards safer intrapartum electronic fetal monitoring (SaferEFM): a human factors/ergonomics investigation – SaferEFM

Intrapartum electronic fetal monitoring is a technique used during labour to monitor fetal well-being during labour. A trace is continuously printed, showing the baby and the mother's heartrate. By reading this trace, midwives and obstetricians make an opinion on how the baby is coping with labour. The technique is involved in multiple serious incidents every year in France and abroad, leading to dozens of stillbirths and neonatal injuries that leave newborns handicapped for life.

Previous research has focused mostly on evaluating individual competence at reading fetal monitoring traces. It has failed to consider broader factors, such as team interactions, equipment design and availability, workload, or collective situation awareness. The problem remains and was highlighted again by the French Haute Autorité de Santé last year.

We propose a human factors/ergonomics approach, where we posit that fetal monitoring must be considered as a complex sociotechnical process. We propose a multimethod approach to assess how risks occur in this process. Using field observations and multimodel analysis, we will assess how fetal monitoring is undetaken in everyday practice. With a national survey, we will analyse variations in practice between maternity units. Using verbal protocol analysis, we will analyse how midwives and obstetricians read fetal monitoring traces, and the factors that affect this process. Combining these methods, we will obtain a comprehensive diagnostic of how fetal monitoring is conducted in France.

We will explore how the different methods complement each other to build a model of how factors at different levels (individual, team, organization, extra-organizational) interact to affect how fetal monitoring is conducted on the ground. This work will contribute to better maternity safety, and to human factors/ergonomics research methodology and application in health services.