Newly Qualified Midwife (NQM)/Early Career Midwife (ECM) Support for CTG Reviews and Case Oversight, SOP

As per the NICE Fetal monitoring in labour guideline (Recommendations | Fetal monitoring in labour | Guidance | NICE) all midwives are expected to undertake a full clinical assessment of the woman in labour, including the CTG, and obtain an in-person review by another clinician every hour. This is done via the “peer CTG review” form in Badgernet. In the case of NQM/ECM this review should be done by a –

• Band 7 charge midwife
• If a band 7 charge midwife is not available their assigned preceptor or clinical skills midwife
• In exceptional circumstances where a band 7 charge midwife, preceptor or clinical skills midwife is not available an experienced band 6 midwife may review the CTG
• In a situation where a peer CTG review by an experienced band 6 is classified as suspicious or pathological this should be escalated as soon as possible to senior midwifery and/or obstetric staff
• At no time should an NQM/ECM peer review the CTG of another NQM/ECM or band 6 midwife

It is the NQM/ECM’s responsibility to seek out peer CTG reviews every hour. However, it is suggested a “buddy” system is put in place to ensure they are being completed and gives the NQM/ECM a designated person to ask throughout the period of care. The initial “buddy” should be a band 7 charge midwife and a secondary experienced band 6 identified if this person is unavailable in the order as above. This provides real time feedback and support to the NQM/ECM, ensuring they are meeting this requirement of labour care and improves safe and effective care provided to women.

If the NQM/ECM is caring for a woman with an antenatal CTG this should be peer reviewed before completion by -

• A band 7 midwife if in labour ward (following the above if the band 7 midwife is not available)
• If in triage, daycare or antenatal ward the named preceptor or a senior band 6 midwife
• It is best practice that the CTG of a band 6 midwife should not be peer reviewed by an NQM/ECM however, this may occur when no other band 6 is available and when the CTG is agreed to be classified as normal. Where the CTG is classified by either as abnormal another band 6 midwife should be sought to provide the peer CTG review
• At no time should an NQM/ECM peer review the CTG of another NQM/ECM

The CTG should be peer reviewed at the bedside before discontinuing. All CTGs for women less than 32 weeks should also be reviewed by a member of the obstetric team following completion. If the NQM/ECM has concerns that any antenatal CTG is abnormal at any time they should request immediate peer review as above.

Whilst caring for women in labour the NQM/ECM should have consistent support and guidance throughout the period of care.

It is recommended that the “buddy” midwife who is assigned to peer review the CTG takes this role and receives an updated verbal SBAR from the NQM/ECM throughout the care period at 4 hourly intervals (ideally aligned with reassessment of progress in labour). Other times where a full verbal SBAR update should be sought are, but not limited to –

• Where the CTG is suspicious or pathological
• Where there is deviation from normal in maternal observations
• Where there are evolving risk factors identified – ie meconium, PV loss
• Where the NQM/ECM has any other concerns or feels they need to discuss an aspect of care for advice

Every 4 hours a risk assessment on Badgernet should be carried out by the NQM/ECM following this discussion. If changes to the plan of care should take place a transfer of care form and SBAR handover should also be completed on Badgernet.

Consideration should be given to the woman’s risk factors when allocating workload in labour ward. Whilst all NQM/ECM should be provided with support as needed, regardless of risk factors, CMs should consider additional support by a preceptor, clinical skills midwife or senior band 6 midwife, if allocating women requiring complex care. This includes, but is not limited to, the following

• Diabetic women - VRIII in use
• Pre-eclampsia or Eclampsia protocol in use
• Fetus with SGA or abnormal dopplers
• Women under FMU with complex fetal abnormalities
• Women with emergent APH
• Women requiring UCB
• Cardiac condition impacting care
• Preterm birth
• Sepsis 6 care
• HDU care
• Providing care for women experiencing fetal loss
• Women requiring care for VBAC
• Women with previous OASI injuries