Feature ArticlesMaternity Providers' Perspectives on Barriers to Utilization of Intermittent Fetal Monitoring A Qualitative StudyChuey, Meagan PhD, CNM; De Vries, Raymond PhD; Dal Cin, Sonya PhD; Low, Lisa Kane PhD, CNMAuthor Information Division of Women's Health, Department of Obstetrics and Gynecology (Dr Kane Low), School of Nursing (Dr Chuey), Center for Bioethics and Social Sciences in Medicine (Dr De Vries); and Research Center for Group Dynamics (Dr Dal Cin), University of Michigan, Ann Arbor. Corresponding Author: Lisa Kane Low, PhD CNM, School of Nursing, University of Michigan, 400 North Ingalls Ste 3160, Ann Arbor, MI 48109 ([email protected]). Funding for this study was provided by the University of Michigan MCubed program and the Greenwall Foundation.The authors acknowledge the contributions of the Electronic Fetal Monitoring (EFM) Project research team, including Megan Masten, Denise Lillvis, and Jennifer Torres, who supported the project in its early phases.Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.Each author has indicated that he or she has met the journal's requirements for Authorship.Submitted for publication: September 7, 2019; accepted for publication: October 25, 2019. The Journal of Perinatal & Neonatal Nursing: January/March 2020 - Volume 34 - Issue 1 - p 46-55 doi: 10.1097/JPN.0000000000000453 Buy Metrics Abstract There are 2 approaches to fetal assessment during labor: continuous electronic fetal monitoring (EFM) and intermittent auscultation (IA). The vast majority of healthy labors in the United States use EFM, despite professional organization recommendations against its use for low-risk pregnancies. This qualitative investigation explores maternity care team members' perspectives on why EFM is the dominant approach to fetal assessment instead of IA. Focus groups comprised of nurses, midwives, and physicians were conducted using a semistructured interview guide. Transcripts were analyzed using directed content analysis to identify themes related to clinical and nonclinical factors influencing the type of fetal assessment employed during labor. Seven focus groups with a total of 41 participants were completed. Seven themes were identified: clinical environment; technology; policies, procedures, and evidence-based protocols; patient-centered influences; fear of liability; providers as members of healthcare team; and deflection of responsibility. All maternity care team members had knowledge of the evidence base supporting IA use for low-risk care. Nurses identified unique challenges in having agency over monitoring decision making and executing best practices. Improved communication among team members can facilitate evidence-based approaches to IA use, facilitating increased utilization for low-risk labor care. © 2020 Wolters Kluwer Health, Inc. All rights reserved.