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Why is Listen2Baby important?

For women experiencing an uncomplicated labour, UK guidance recommends that midwives monitor the baby's heart rate using a hand-held fetal stethoscope or ultrasound device.

Image of a midwife kneeling on the floor in front of a pregnant woman and using hand-held fetal stethoscope to listen to the baby.

This is known as 'intermittent auscultation' (IA), which means 'listening at regular intervals', and is used in the labours of up to 300,000 women every year in the UK. National guidance says that midwives should listen to the baby's heart rate straight after a contraction for at least one minute, and that they should do this and record the baby's heart rate every fifteen minutes during the first stage of labour, and every five minutes in the second (pushing) stage. Several national investigations have found issues with the way IA is carried out in practice that have contributed to death or severe injury in babies. Problems include IA not being carried out at the right time or often enough; the baby's heart rate not being recorded properly; and midwives not recognising or acting on concerns about the baby's heart rate.

Midwife using an ultrasound device to listen to the baby of a pregnant woman in a birthing pool

There is no research evidence about the best way to do IA in practice, including what is the best device or counting method to use, and we don't know why IA is not always carried out in line with national guidance. Our proposed research will provide high quality evidence in an area where there is almost none at present and where national enquiries have repeatedly recommended further research and quality improvement. It will also provide evidence more generally about how to support practice change and implement guidance in maternity care.

Listen2Baby comprises five work packages

We will carry out a survey of all UK NHS organisations to find out what IA devices, counting methods and training packages midwives use (work package 1). We will watch midwives using IA in different units across the UK and talk to them about what doing IA is like from their point of view (work package 2). We will also speak to women with different experiences of having their baby's heart rate monitored using IA (work package 3). We will collect the key points from all this information.

Together with midwives, women and other experts we will then use 'experience-based co-design' (EBCD) to design a practical 'toolkit' to improve the practice of IA (work package 4). This means holding meetings to feed back the research results to midwives, women and partners, and others with an interest or expertise in IA. We will discuss the results together, agree what to work on and form small co-design groups to design solutions. Together these solutions will form our 'toolkit', which we will then test in a small number of units to see whether and how it works (work package 5). Finally, we will get everyone involved together to share the final 'toolkit'. We don't know what the 'toolkit' will look like yet because it will come out of the EBCD process, but it could include a website, videos, posters or prompt cards.

Throughout the project, we will work closely with women, midwives, and senior NHS and government policy colleagues to make sure that the results of this research, and the 'toolkit' we produce, will lead to changes in practice to improve the way that IA is carried out.