Perspectives on 50 years of fetal monitoring from clinical leaders around the world

Dr Deborah Fox
Dr. Deborah Fox
Lecturer in Midwifery at the University of Technology Sydney, and Member of the Scientific Review Advisory Committee of the Australian College of Midwives

1. How have advances in technology changed the way you work?
Out of all the advances I’ve seen in over a decade as a midwife, I would particularly highlight cordless waterproof fetal monitoring technology. I think it has been crucial in enhancing how we support women who require continuous fetal monitoring during childbirth.

 

I’ve been working with Philips to help spread awareness of this technology among clinicians in Australia. Having seen the benefits first-hand, I feel it’s important to get the message out there.


2. Which developments have surprised you the most during your time in the field of obstetrical care?
I’ve been pleasantly surprised by progress in developing technology that allows women with complications to have a normal birth. Also, even though I’ve been aware of cordless waterproof technology for a decade now, the ability to wirelessly monitor twins and triplets, and maternal blood pressure and oxygen saturation, has certainly been a significant innovation.


Beyond that, I would also highlight advances in fetal surgery as a very exciting area of development, with a view to improving babies’ health.


3. How has the labor experience evolved from the mother’s perspective?
Women are becoming more informed about their options, and as a midwife, I think that’s something we should embrace. The more information we can share with them to help them make choices, the better. While the midwife is the expert in childbearing, the woman is the expert in her own life and needs, and those of her family. Those two things have to go together, and that means understanding and responding to the mother’s emotional, psychological, cultural and social needs – rather than treating childbirth as a purely medical procedure.


4. How have public and clinical attitudes changed with respect to mobility in labor?
I think that more women than ever recognize the importance of freedom in labor. However, a lot of women still assume that they will be expected to sit or lie flat on their back on the bed. This means we need to work with women during pregnancy to help them understand that they do have choices, and that we will be ready and able to support them if they do desire mobility.

 

From the clinical perspective, I think that more and more midwives – especially those who have been trained and educated in the last 10 to 20 years – have a firm grasp of the physiological importance of freedom of movement and positioning in labor. That’s certainly a focus of my teaching and training of midwifery students.


5. What future advances would you like to see in the field of labor and delivery that would improve your job or the mother’s experience?
My dream birthing room would have a bath, waterproof cordless monitoring, and comfortable chairs, stools, cushions and other furniture for the mother to lean on – so the whole idea of lying flat on her back doesn’t even enter her head. If anything, I would like to see beds removed from birthing rooms altogether, or moved to the side so that the bed is not the focus of the room.

 

This should be combined with midwifery continuity of care, so that every woman gets their own midwife and builds a one-to-one relationship with them. With all the psychosocial factors involved in pregnancy and labor, this continuity is crucial. If we could deliver that for all women, not just those with a low risk of complications, I think that it would have a huge positive impact on the quality of maternity care overall.