Changing the monitoring plan — communication and decision-making station

Communication and shared decision-making station: renegotiating the fetal monitoring plan with a woman whose birth preferences are being changed by a clinical development. Tests honest presentation of the evidence in both directions, respect for autonomy, offering telemetry rather than a bed, handling an angry support person, and documenting a declined recommendation safely. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 29-year-old G1 at 41+0 weeks is in spontaneous labour at 4 cm. Her written birth preferences ask for no continuous monitoring, freedom to move, and the birth pool. Four hours later progress has slowed, the midwife recommends oxytocin augmentation, and the woman has agreed. She has now been told she will need continuous CTG and is distressed, saying she was promised she could stay mobile. She is asking you directly whether the monitor is really necessary and whether she can refuse it. Her partner is present and is arguing that the hospital is 'just covering itself'.

Station brief

Format. Communication and shared decision-making station, approximately 12 minutes, with a simulated woman and a simulated partner. There is no procedure to perform. You are being assessed on whether you can give an honest, numerate explanation, respect a decision you disagree with, and still keep the labour safe. ^[2]^[1]

Candidate instruction. Explain why continuous monitoring is being recommended now, answer her question about refusing it, respond to her partner, and agree a plan. ^[2]^[3]

References7Show

[1]Alfirevic Z, Devane D, Gyte GM, et al. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour Cochrane Database Syst Rev, 2017.PMID 28157275
[2]Yeoh M, Ameratunga D, Lee J, et al. Simplifying the language of fetal monitoring Aust N Z J Obstet Gynaecol, 2019.PMID 30460717
[3]Fox D, Maude R, Coddington R, et al. The use of continuous foetal monitoring technologies that enable mobility in labour for women with complex pregnancies: A survey of Australian and New Zealand hospitals Midwifery, 2021.PMID 33260005
[4]Watson K, Mills TA, Lavender T Experiences and outcomes on the use of telemetry to monitor the fetal heart during labour: findings from a mixed methods study Women Birth, 2022.PMID 34219033
[5]Lewis D, Downe S FIGO consensus guidelines on intrapartum fetal monitoring: Intermittent auscultation Int J Gynaecol Obstet, 2015.PMID 26433400
[6]Tome M, Lovers AAK, Impey L, et al. Revisiting the Value of Admission Cardiotocography in Term Pregnancies: An Updated Systematic Review and Meta-Analysis BJOG, 2026.PMID 41074594
[7]Simpson KR Avoiding confusion of maternal heart rate with fetal heart rate during labor MCN Am J Matern Child Nurs, 2011.PMID 21709529

Changing the monitoring plan — communication and decision-making station

Station brief

Candidate instruction. Explain why continuous monitoring is being recommended now, answer her question about refusing it, respond to her partner, and agree a plan. ^[2]^[3]

References7Show

[1]Alfirevic Z, Devane D, Gyte GM, et al. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour Cochrane Database Syst Rev, 2017.PMID 28157275
[2]Yeoh M, Ameratunga D, Lee J, et al. Simplifying the language of fetal monitoring Aust N Z J Obstet Gynaecol, 2019.PMID 30460717
[3]Fox D, Maude R, Coddington R, et al. The use of continuous foetal monitoring technologies that enable mobility in labour for women with complex pregnancies: A survey of Australian and New Zealand hospitals Midwifery, 2021.PMID 33260005
[4]Watson K, Mills TA, Lavender T Experiences and outcomes on the use of telemetry to monitor the fetal heart during labour: findings from a mixed methods study Women Birth, 2022.PMID 34219033
[5]Lewis D, Downe S FIGO consensus guidelines on intrapartum fetal monitoring: Intermittent auscultation Int J Gynaecol Obstet, 2015.PMID 26433400
[6]Tome M, Lovers AAK, Impey L, et al. Revisiting the Value of Admission Cardiotocography in Term Pregnancies: An Updated Systematic Review and Meta-Analysis BJOG, 2026.PMID 41074594
[7]Simpson KR Avoiding confusion of maternal heart rate with fetal heart rate during labor MCN Am J Matern Child Nurs, 2011.PMID 21709529