1.1 Introduction
Fetal monitoring refers to the process of observing and assessing the fetal heart rate and uterine contractions during pregnancy and labor to ensure the well-being of the fetus and to detect any signs of fetal distress (American College of Obstetricians and Gynecologists, 2020). It is primarily performed through methods such as intermittent auscultation using a Doppler device or fetoscope, and continuous electronic fetal monitoring (EFM), which involves the use of cardiotocography (CTG) to provide real-time information on fetal heart rate and maternal uterine activity (Alfirevic et al., 2017).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.
1.2 Background of Study
The evolution of fetal monitoring traces a path from simple bedside listening to sophisticated electronic systems, with each step motivated by the desire to identify fetal compromise early enough to influence labor and delivery outcomes. in the nineteenth century, clinicians relied on direct auscultation of the fetal heart with wooden or metal stethoscopes, later refined into the fetoscope, establishing the principle that fetal heart rate patterns mirror fetal well being (Chandraharan & Arulkumaran, 2019). As obstetrics modernized, hand held Doppler devices extended this tradition by amplifying fetal heart sounds and allowing intermittent checks during labor, a practice that remains central to intrapartum care in many settings (World Health Organization [WHO], 2018).
Fetal monitoring has become a cornerstone of obstetric practice, particularly in ensuring the safety of both mother and fetus during labor and delivery. According to the American College of Obstetricians and Gynecologists (2020), fetal monitoring is essential for evaluating fetal well-being during labor, primarily through assessing fetal heart rate patterns and uterine contractions. This practice aids healthcare providers in identifying signs of fetal distress, which allows for timely interventions that may prevent adverse outcomes such as birth asphyxia, stillbirth, or neurological damage.
Alfirevic et al. (2017) reported that the two most common methods of fetal monitoring are intermittent auscultation and continuous electronic fetal monitoring (EFM), with the latter providing real-time insights through cardiotocography. However, the effectiveness of continuous monitoring has been questioned over time. Devane et al. (2012) asserted that although EFM may reduce the risk of neonatal seizures, it has not significantly reduced the rate of perinatal mortality or cerebral palsy and is often associated with an increased rate of cesarean and instrumental deliveries.
In low- and middle-income countries like Nigeria, the application of fetal monitoring presents both opportunities and challenges. Abiodun and Salihu (2021) contended that while fetal monitoring is vital in improving maternal and neonatal outcomes, its use is often hindered by inadequate equipment, insufficient training, and inconsistent interpretation of results (Abiodun and Salihu, 2021).
Chandraharan and Arulkumaran (2019) affirmed that misinterpretation of fetal heart rate patterns remains a significant issue globally, sometimes leading to unnecessary interventions or missed signs of genuine fetal compromise. Similarly, Smith et al. (2019) stated that continuous fetal monitoring can negatively affect the labor experience for some women, particularly by restricting mobility and increasing anxiety. While extensive research has been conducted in developed countries on the outcomes of fetal monitoring, there remains a gap in understanding its impact in resource-constrained settings. Local health systems differ significantly in terms of capacity, policy, and clinical practice, which may influence the effectiveness of monitoring strategies. As a result, there is a growing need to evaluate the role of fetal monitoring in improving delivery outcomes within specific contexts.
The practice of fetal monitoring plays a crucial role in obstetric care by enabling timely medical decisions that support safe labor and delivery. It is particularly useful in identifying complications such as fetal hypoxia, and abnormal heart rate patterns that could signal the need for medical intervention (Chandraharan & Arulkumaran, 2019). In many health facilities, fetal monitoring is considered standard practice during labor, especially in high-risk pregnancies or where complications are anticipated. However, the clinical outcomes of fetal monitoring continue to generate debate. While its intended purpose is to reduce perinatal mortality and morbidity, emerging evidence suggests that continuous electronic monitoring is associated with a rise in cesarean sections and instrumental deliveries, often without corresponding improvements in neonatal outcomes (Devane et al., 2012). In low- and middle-income countries such as Nigeria, the availability and quality of fetal monitoring services are often challenged by inadequate infrastructure, limited skilled personnel, and inconsistent interpretation of fetal monitoring data (Abiodun & Salihu, 2021).
This study is set against the backdrop of a growing demand for evidence-based practices in maternal healthcare and the need to optimize labor management through effective and context-sensitive monitoring approaches.
1.3 Statement of Problems
Investigation revealed that many healthcare settings, especially in low-resource regions, experiences inconsistent application of fetal monitoring techniques, and it affects the quality of care during labor. On the other hand, where monitoring is not properly utilized or interpreted, complications that are otherwise preventable are sometimes missed, resulting in adverse maternal or fetal outcomes.
Furthermore, the psychological impact on pregnant women undergoing intensive monitoring during labor is often overlooked. Continuous monitoring is known to limit maternal mobility and increase anxiety, which may influence the natural progression of labor and the woman’s overall birthing experience.
There is also a gap in communication between healthcare providers and patients regarding the purpose and implications of monitoring results, which leads to confusion and mistrust. It is against this backdrop that this study seeks to investigate the impact of fetal monitoring on labor and delivery outcomes, with a focus on identifying the effectiveness, limitations, and potential implications for maternal and neonatal care.
1.4 Aim and Objectives of Study
The aim of the study is to assess the impact of fetal monitoring on labor progression and delivery outcomes. In achieving this aim, the following specific objectives were laid out as follows:
- To determine the relationship between fetal monitoring and the rate of cesarean and instrumental deliveries.
- To evaluate the effectiveness of fetal monitoring in detecting fetal distress during labor in the study area.
- To identify the challenges associated with the implementation of fetal monitoring in labor wards.
- To assess the knowledge and competence level of healthcare providers in using fetal monitoring techniques.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the relationship between fetal monitoring and the rate of cesarean and instrumental deliveries?
- How effective is fetal monitoring in detecting fetal distress during labor?
- What is the level of knowledge and competence of healthcare providers in using fetal monitoring techniques?
- What are the major challenges faced in implementing fetal monitoring during labor?
1.6 Significance of Study
It is believed that at the completion of the study, the findings will contribute to improving maternity care by providing evidence that will support better training and decision-making. The study will also serve as a foundation for developing standardized fetal monitoring protocols suitable for local health systems.
Furthermore, medical educators will use the findings to update obstetrics training curricula, ensuring more practical and evidence-based learning. Additionally, it will open up opportunities for further research into best practices for intrapartum care.
Lastly, pregnant women will be more likely to experience safer deliveries due to improved labor monitoring and timely interventions. The research will also inform health policymakers and hospital administrators on the gaps that need addressing to optimize maternal and neonatal outcomes.
1.7 Scope of Study
This study is limited to labor and delivery units in Lagos University Teaching Hospital (LUTH), Lagos State, Nigeria. It will focus on healthcare providers’ use of fetal monitoring during labor and how it impacts delivery outcomes within this facility.
1.8 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.9 Definition of Terms
Fetal Monitoring:
Fetal monitoring is the clinical practice of observing and recording the fetal heart rate and uterine contractions during labor, used to assess fetal well-being and detect potential distress (Alfirevic et al., 2017).
Labor:
Labor refers to the physiological process by which the fetus is expelled from the uterus through the birth canal, marked by regular uterine contractions and cervical dilation (Chandraharan & Arulkumaran, 2019).
Delivery Outcomes:
Delivery outcomes include the clinical results for both mother and baby following childbirth, such as mode of delivery, birth weight, APGAR score, and maternal complications (Devane et al., 2012).
Electronic Fetal Monitoring (EFM):
EFM is a method of continuous fetal surveillance using a cardiotocograph to record fetal heart rate patterns and uterine contractions during labor (ACOG, 2020).
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