Intersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspective
Abstract Background Intrapartum Electronic Fetal Monitoring interpretation is subjective, variable and dependent on clinical expertise. Electronic Fetal Monitoring is also influenced by human factors, such as the labour ward context, staffing pressures, situational awareness, local protocols, workfl...
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2025-06-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-025-07765-z |
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| author | Verónica Blanco Gutiérrez Lyuba V. Bozhilova Natalie Darko Antoniya Georgieva Kenton O’Hara |
| author_facet | Verónica Blanco Gutiérrez Lyuba V. Bozhilova Natalie Darko Antoniya Georgieva Kenton O’Hara |
| author_sort | Verónica Blanco Gutiérrez |
| collection | DOAJ |
| description | Abstract Background Intrapartum Electronic Fetal Monitoring interpretation is subjective, variable and dependent on clinical expertise. Electronic Fetal Monitoring is also influenced by human factors, such as the labour ward context, staffing pressures, situational awareness, local protocols, workflow variations, team dynamics, and reporting cultures. This paper explored whether, and how, socio-technical factors may have the potential to contribute to disparities in intrapartum Electronic Fetal Monitoring care and their implications for maternal and neonatal health. Methods This study employed an exploratory qualitative design to investigate clinicians’ experiences of Electronic Fetal Monitoring. Eighteen semi-structured interviews were undertaken online with midwives, student midwives and obstetricians involved in labour ward care in the UK. Critical Race Feminism and Intersectionality theories shaped the study design and analysis. Interviews were analysed using reflexive thematic analysis. Results Seven themes were identified under the overarching theme intersectional dynamics in intrapartum Electronic Fetal Monitoring: 1) Social determinants in Electronic Fetal Monitoring interpretation, (2) Disparities in care expectations and decision agency, (3) Cultural influence on decision choices, (4) Disparities in communication, (5) Rationalising Electronic Fetal Monitoring outcomes towards preferred course of action, (6) Stereotypes and bias, and (7) Wider influences of Electronic Fetal Monitoring and labour care. Conclusions Electronic Fetal Monitoring is a socially and contextually interpreted tool used to support particular interventions or inactions. Electronic Fetal Monitoring management is subject to systematic contextual influences, maternal Social Determinants of Health and biases that may further contribute to disparities in labour care and outcomes. Addressing maternal Social Determinants of Health while providing Electronic Fetal Monitoring care is vital to promoting equitable care, facilitating a positive experience and improving health outcomes. |
| format | Article |
| id | doaj-art-e19acffac25b43fb993c06d4b224289e |
| institution | OA Journals |
| issn | 1471-2393 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj-art-e19acffac25b43fb993c06d4b224289e2025-08-20T02:31:09ZengBMCBMC Pregnancy and Childbirth1471-23932025-06-0125111910.1186/s12884-025-07765-zIntersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspectiveVerónica Blanco Gutiérrez0Lyuba V. Bozhilova1Natalie Darko2Antoniya Georgieva3Kenton O’Hara4EPSRC Centre for Doctoral Training in Digital Health and Care, University of BristolOxford Labour Monitoring Group, Nuffield Department of Women’s & Reproductive Health, University of OxfordCollege of Life Sciences, University of LeicesterOxford Labour Monitoring Group, Nuffield Department of Women’s & Reproductive Health, University of OxfordSchool of Computer Science, University of BristolAbstract Background Intrapartum Electronic Fetal Monitoring interpretation is subjective, variable and dependent on clinical expertise. Electronic Fetal Monitoring is also influenced by human factors, such as the labour ward context, staffing pressures, situational awareness, local protocols, workflow variations, team dynamics, and reporting cultures. This paper explored whether, and how, socio-technical factors may have the potential to contribute to disparities in intrapartum Electronic Fetal Monitoring care and their implications for maternal and neonatal health. Methods This study employed an exploratory qualitative design to investigate clinicians’ experiences of Electronic Fetal Monitoring. Eighteen semi-structured interviews were undertaken online with midwives, student midwives and obstetricians involved in labour ward care in the UK. Critical Race Feminism and Intersectionality theories shaped the study design and analysis. Interviews were analysed using reflexive thematic analysis. Results Seven themes were identified under the overarching theme intersectional dynamics in intrapartum Electronic Fetal Monitoring: 1) Social determinants in Electronic Fetal Monitoring interpretation, (2) Disparities in care expectations and decision agency, (3) Cultural influence on decision choices, (4) Disparities in communication, (5) Rationalising Electronic Fetal Monitoring outcomes towards preferred course of action, (6) Stereotypes and bias, and (7) Wider influences of Electronic Fetal Monitoring and labour care. Conclusions Electronic Fetal Monitoring is a socially and contextually interpreted tool used to support particular interventions or inactions. Electronic Fetal Monitoring management is subject to systematic contextual influences, maternal Social Determinants of Health and biases that may further contribute to disparities in labour care and outcomes. Addressing maternal Social Determinants of Health while providing Electronic Fetal Monitoring care is vital to promoting equitable care, facilitating a positive experience and improving health outcomes.https://doi.org/10.1186/s12884-025-07765-zQualitative researchIntrapartum electronic fetal monitoringSocial determinants of healthDecision-makingCTGPerinatal disparities |
| spellingShingle | Verónica Blanco Gutiérrez Lyuba V. Bozhilova Natalie Darko Antoniya Georgieva Kenton O’Hara Intersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspective BMC Pregnancy and Childbirth Qualitative research Intrapartum electronic fetal monitoring Social determinants of health Decision-making CTG Perinatal disparities |
| title | Intersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspective |
| title_full | Intersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspective |
| title_fullStr | Intersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspective |
| title_full_unstemmed | Intersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspective |
| title_short | Intersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspective |
| title_sort | intersectional dynamics and care disparities in intrapartum electronic fetal monitoring a socio technical systems perspective |
| topic | Qualitative research Intrapartum electronic fetal monitoring Social determinants of health Decision-making CTG Perinatal disparities |
| url | https://doi.org/10.1186/s12884-025-07765-z |
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