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e-learning programme for intelligent intermittent auscultation in labour


Intelligent Intermittent Auscultation (IIA) is the recommended method of monitoring the heart rates of babies in the womb where pregnant women are considered at low risk of fetal hypoxia during labour. It is a practical skill required of all midwives in any birth setting.

The Oxford AHSN has developed an interactive e-learning package with consultant midwives Christine Harding (Royal Berks) and Wendy Randall (Oxford University Hospitals). It was launched on the national Health Education England e-LfH platform in January 2020 following masterclass webinars attended by more than 300 people. In February 2021 access was extended worldwide through the eIntegrity platform.

In November 2020 it won the Innovation of the Year category at the HSJ Patient Safety Awards and received professional accreditation from the Royal College of Midwives.

The aim is to improve safety for mothers and babies in low risk labour and birth by improving the knowledge, skills and confidence of midwives. Uniquely the programme uses real fetal heart sounds as part of the interactive learning. It enables midwives to build up an accurate picture of how the baby is coping with the stress of contractions based on what they are hearing and take the right next steps based on whether they identify any deterioration or abnormalities in the fetal heart rate. It provides reassurance for well babies and prompts rapid escalation and a move to continuous electronic fetal monitoring if appropriate.

The training package supports the NHS Long Term Plan and responds to national reports (Each Baby Counts, RCOG, 2015 Full ReportEach Baby Counts RCOG 2018 Progress Report; Saving Babies Lives V2, NHSE 2019) which highlight the importance of intermittent auscultation and identify specific training requirements.

It is the only training package that accurately assesses competency relating to IIA. Up to now it was only possible to teach the theory and assess knowledge. The new programme includes an assessment which identifies if the midwife/learner requires additional support.