When Evidence Fails to Change Practice: Examining the Persistence of Continuous Fetal Monitoring

Area of Science:

• Obstetrics and Gynecology
• Evidence-Based Medicine Implementation
• Health Services Research

Background:

• Continuous electronic fetal monitoring (cEFM) is widely used in labor despite evidence showing no benefit over intermittent auscultation (IA) for uncomplicated cases.
• Research indicates cEFM may lead to unnecessary interventions in low-risk pregnancies.
• The persistent use of cEFM highlights challenges in translating scientific evidence into clinical practice within obstetrics.

Purpose of the Study:

• To investigate the factors contributing to the continued use of cEFM in labor, even when evidence supports alternatives like IA.
• To understand the barriers to implementing evidence-based fetal monitoring practices in obstetric care.
• To provide insights into overcoming resistance to evidence-based practice in other medical specialties.

Main Methods:

• Qualitative study involving direct observations on a labor and delivery unit.
• Interviews with key informants (clinicians, healthcare providers) to gather in-depth perspectives.
• Analysis of clinician behaviors and unit workflow to identify decision-making drivers for fetal monitoring.

Main Results:

• Several factors were identified that drive the non-evidence-based use of cEFM.
• Key drivers include fear of medical liability, clinician training, hospital unit policies, perceived patient expectations, and unit workflow dynamics.
• These factors collectively contribute to the persistence of cEFM despite contrary scientific evidence.

Conclusions:

• Aligning fetal assessment during labor with research evidence requires addressing systemic and practice-level barriers.
• Recommendations include enhanced education for parents and clinicians, hospital policies promoting evidence reflection, and challenging protocols that discourage IA.
• Highlighting the clinical and economic benefits of evidence-based practice is crucial for promoting change.